[Implementation of prehospital transfusion in case of trauma shock]. / Instauration d'un protocole de transfusion préhospitalière dans le choc hémorragique traumatique.

Transfusion plays a major role in the management of hemorrhagic shock where every minute counts. A pre-hospital transfusion protocol is established in the medical vehicle within the emergency department of CHR hospital Liège. It is based on predefined clinical and biological severity criteria which allow us to start a massive transfusion protocol as early as possible and thus to optimize its effect during traumatic hemorrhagic shock.

La transfusion occupe une place majeure dans la prise en charge du choc hémorragique où chaque minute compte. Un protocole de transfusion préhospitalière est instauré via le véhicule SMUR (Service Mobile d'Urgence-Réanimation) au sein du service des urgences du CHR de Liège. Il est basé sur des critères de gravité cliniques et biologiques prédéfinis qui permettent de débuter, le plus précocement possible, un protocole de transfusion massive et, ainsi, d'optimaliser son effet lors de choc hémorragique traumatique.

[How I treat a poisoning with tricyclic antidepressants : potential role of a treatment with lipid emulsion]. / Comment je traite l'intoxication aux antidépresseurs tricycliques : efficacité potentielle d'un traitement par émulsion lipidique.

Poisoning with tricyclic antidepressants is common and can be life-threatening. The classic management is well known (chelating gastrointestinal, sodium bicarbonate, benzodiazepine, norepinephrine). A few years ago, a treatment with lipid emulsion, previously used in local anesthetics poisoning, has been successfully tested in tricyclic poisoning with cardiac arrest. We are currently unable to explain the exact mechanism of this treatment but it could have a place in the treatment of severe tricyclic poisoning with hemodynamic instability in addition to the conventional treatment.

L'intoxication aux antidépresseurs tricycliques n'est pas rare et peut engager le pronostic vital du patient. La prise en charge classique est bien connue (chélateurs gastrointestinaux, bicarbonate de sodium, benzodiazépines, amines vasoactives). Il y a quelques années, un traitement par émulsion lipidique, jusque-là utilisé dans les intoxications aux anesthésiques locaux, a été testé avec succès dans les intoxications aux tricycliques en arrêt cardio-respiratoire. Nous sommes, actuellement, incapables d'expliquer le fonctionnement exact de ce traitement, mais il pourrait avoir une place dans la prise en charge des intoxications aux tricycliques avec instabilité hémodynamique échappant au traitement conventionnel.

[Surgical fixation in flail chest : a local first encouraging experience]. / Fixation chirurgicale d'un volet thoracique : à propos d'une première procédure encourageante (cas clinique).

We report the case of a young woman who suffered from a severe traffic accident with major thoracic trauma consisting of hemopneumothorax and flail chest. At day 5 of mechanical ventilation, a surgical reduction and fixation of the fractured ribs were performed; the patient was liberated from mechanical ventilation the next day and discharged from the intensive care unit two days later. The success of this local first case incites us to further a similar approach in such challenging trauma cases.

Nous rapportons le cas d'une jeune patiente victime d'un accident grave de la circulation avec un traumatisme thoracique sévère ayant entraîné un hémopneumothorax et un volet thoracique. Au 5ème jour de ventilation invasive, une réduction et une fixation chirurgicales du volet thoracique furent réalisées. La patiente fut sevrée de la ventilation invasive le lendemain et transférée en salle de soins banalisés deux jours plus tard. Le succès de cette première thérapeutique nous incite à la proposer à l'avenir dans des situations similaires.

Massive Transfusion Protocol: a local two years' experience.

Evidence supporting the implementation of a Massive Transfusion Protocol (MTP) and its effect on patients' outcome is still limited. However, we implemented in June 2013 a local MTP for trauma and nontrauma massively bleeding patients. Twenty months later, we propose here a short presentation of our MTP population and a critical analysis of the actual data supporting MTP implementation.

Effectiveness of intubating laryngeal mask airway (ILMA Fastrach) used by nurses during out of hospital cardiac arrest resuscitation.

OBJECTIVE: ILMA Fastrach is a recognized alternative to classic laryngoscopic intubation. In this study, we evaluated the success rate of intubation with Fastrach, used by emergency nurses who have no experience of field intubation. METHODS: Twelve untrained nurses used Fastrach during 71 out of hospital cardiac arrests (OHCAs). Each step time of resuscitation was recorded. RESULTS: Fastrach effective ventilation was obtained in 97%. Rate of successful intubation was 86%. CONCLUSIONS: ILMA Fastrach is a good alternative to classical laryngoscopic intubation by untrained nurses, even in difficult conditions such as OHCAs.

[The current status of organ transplantation: the role of xenotransplantation?]. / Etat actuel des transplantations d'organes: place à la xénotransplantation?

In the last few years, transplantation was an area of intense research activity. However, there is a worldwide shortage of donor organs for clinical transplantations. Currently, interest in xenotransplantation research is growing not only because of the increased demand for organs but also because of advances in molecular biology techniques that make possible the genetic or immunological manipulations of the animal donor rather than the human recipient. The better definitions of the mechanisms responsible for xenograft rejection should facilitate appropriate therapeutic strategies for long xenograft survival.

Tramadol, an alternative to morphine for treating posttraumatic pain in the prehospital situation.

In this randomized, double-blinded, parallel-group study, we compared the efficacy of tramadol and morphine administered IV for the management of pain in trauma patients in the prehospital situation. One-hundred-five patients were randomly allocated to receive tramadol (Group T) or morphine (Group M). The initial dose was 100 mg tramadol in Group T and 5 mg morphine (body weight < or = 70 kg) or 10 mg morphine (body weight >70 kg) in Group M; this could be increased to 200 mg in Group T and 15 or 20 mg in Group M if necessary. Pain intensity was assessed with four-point verbal rating scales. Sedation, physiologic data, and adverse events were also recorded. Analgesia was similar in both groups; the 95% confidence interval for the difference between the decrease in pain intensity observed with tramadol or morphine was -0.26 to 0.30, which was within the predefined equivalence range (-0.50 to 0.50). Neither sedation scores nor physiologic data differed between groups. Tramadol is an acceptable alternative to morphine in the prehospital trauma setting.