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Biomedical subjects

F Adnet

Publications and source records attributed to F Adnet.

At least 19 recordsLinked to original sources
PubMed2005

[Peripheral venous placement: evaluation of guidelines respect in prehospital setting].

INTRODUCTION: Respect of guidelines for peripheral venous placement has never been studied in prehospital setting. OBJECTIVE: Describe prehospital practice in peripheral venous placement and perform comparison with guidelines. MATERIAL AND METHODS: Prospective study, in mobile intensive care unit from a university hospital, October 2002 to January 2003. Study of prehospital practice for peripheral venous placement in prehospital setting and comparison with guidelines. Guideline from Anaes: wearing a cap and a mask, washing hands, washing insertion site with water and soap, wearing sterile gloves, using sterile gauze, applying iodine solution to the insertion site, using catheter with a protective system and applying occlusive dressing. RESULTS: Six hundred seventy-three reports were studied. A cap and a mask wearing and washing insertion site with water and soap were never respected. Washing hand with antiseptic was reported in 56% of the cases, washing insertion site with iodine solution in 4%, wearing sterile gloves in 21%, using catheter with a protective system in 89%, using sterile gauze in 1% and applying occlusive dressing in 99%. For each criterion, respect of guidelines was significantly more frequent in nurse practice than in physician practice. CONCLUSION: Guidelines for peripheral venous placement were not respected in prehospital setting. Education and formation are necessary to optimize infectious risk prevention in prehospital care.

Adolescent↗
PubMed2005

[Intraspinal air, a rare complication of blunt chest trauma].

Pneumorachis, defined as the presence of air within the spinal canal, has rarely been described, and is exceptionally due to thoracic trauma. We report the case of a 37-year-old patient who sustained a motor vehicle accident. The chest CT-scan showed a bilateral-hemothorax, a small right pneumothorax, rib fractures, and a fracture of the fourth thoracic vertebra associated with air in the spinal canal extending from T6 to L2. The fracture of T4 associated with the pleural lesion is probably responsible for the pneumorachis. Possible pathogenic mechanisms of this rare blunt chest complication are discussed.

Accidents, Traffic↗
PubMed2005

Measurement of carbon monoxide in simulated expired breath.

BACKGROUND: Environmental carbon dioxide (CO) detectors used as an early warning method have been adapted to measure CO concentration in expired breath. This technique has been validated in smokers with relatively low CO concentrations, but its applicability to poisoning has not been demonstrated. OBJECTIVE: To compare the reliability of toxicologically significant CO measurements performed using a portable CO detector with those obtained using infrared spectrometry, the standard method for blood CO concentration determination. DESIGN: Experimental study with a CO detector and infrared spectrometer. A balloon simulated respiratory movements and an expired breath. Balloon gas mixtures contained CO, in one of 21 different concentrations from 100 to 600 parts per million (ppm) in air. CO concentration was measured directly with the portable CO detector and two gas samples obtained at the beginning and end of the simulated expired breath were diluted, with validation, for spectrometric measures. MAIN OUTCOME MEASURES: Portable CO detector concentrations were compared with the mean value of the reference method. Simple linear regression was performed using ANOVA to evaluate the parallel between the model with the reference method. RESULTS: Portable CO detector concentration measurements were perfectly linear (R2=0.989, P<10(-3)) over a concentration range of 46-645 ppm. The difference from the reference plot was significant (P<0.01). CONCLUSION: Given the linearity of the measurements, the underestimation by the portable CO detector at higher concentrations can be corrected mathematically. A portable CO detector should measure CO in expired breath efficiently and reliably.

Breath Tests↗
PubMed2004

[Impact of the law of the 4 March 2002 relative to patients' rights on request for medical information received in a medical dispatching center and mobile intensive care unit (Samu 93)].

INTRODUCTION: Law of the 4 March 2002 allowed patient's access to his medical record. This law could increase the number of requests in medical dispatching centers and prehospital intensive care units. OBJECTIVE: The aim of this study was to evaluate the impact of this law on the number of requests for medical information received in our unit. METHODS: Since the promulgation of the law, from March to December 2002, medical requests were prospectively collected and classified in categories including request for transmission of medical record. Requests received before the law, from January 2000 to February 2002 were classified according to the same items. Number of requests received during the two periods were compared according to the total number of medical record managed in our medical dispatching center and prehospital intensive care unit. RESULTS: The total number of requests for medical information significantly increased since the law of March 2002 (results are expressed as cases per month per 10 000 record: 4.8 +/- 2.5 vs. 8.0 +/- 4.5; p = 0.04). Specific request for transmissions of medical record significantly increased since the law (1.3 +/- 1.6 vs. 3.0 +/- 3.0; P = 0.046). This increase was progressive and constant since March 2002. DISCUSSION: Physicians and patients should take in consideration consequences of this law. Physician should be vigilant with the quality of their medical dossiers. Interpretation of this law and its ethics consequences will probably be discussed again as one should not exclude perverse impact of this law. In effect, insurances and mutual insurances companies could find in this law a way to obtain medical information, such as circumstances of death, previously unavailable. CONCLUSION: The law of 4 March 2002 relative to patients' rights significantly increased number of requests for medical information received in our dispatching center and prehospital intensive care unit.

Access to Information↗
PubMed2004

[Victims of fall from height. Study of 287 patients and determination of clinical prognostic factors].

INTRODUCTION: Fall from height is a common cause of severe blunt urban trauma but this mechanism of trauma is poorly documented. OBJECTIVE: To describe initial clinical parameters, injuries and outcome in patients victims of falls from height and to determinate clinical prognostic factors. STUDY DESIGN: Retrospective study from January 1998 to May 1999 and prospective study from June 1999 to September 2000. Inclusions: patients older than 12 year-old victims of falls with height of more than 3 m. PATIENTS AND METHODS: Studied parameters: demographic data, fall circumstances, prehospital clinical evaluation (Glasgow coma scale (GCS), Arterial Blood Pressure (ABP), Heart Rhythm (ER) and revised trauma score (RTS) initial and patients outcome. RESULTS: Two hundred and eighty seven patients were included during 32.5 months; 33% were women and 67% men. Mean age: 37 +/- 16 years. Median height of fall: three stairs (3-4). Final mortality: 34% including 22% death on site with or without resuscitation, 5% before hospitalization, 8% during the first day and 2% later. Independent prognostic factors were GCS (OR = 0.40; IC: 0.25 - 0.65; P = 0.0002), initial ABP (OR = 0.94; IC: 0.90 - 0.98; P = 0.008) and RTS (OR = 2.93; 1.19-7.24; P = 0.02). CONCLUSION: Immediate mortality after fall from heights is high and remains low after day 3. GCS, ABP and RTS are independent prognostic factors.

Accidental Falls↗
PubMed2004

[Prehospital thrombolysis of a pulmonary embolism with a severe shock].

The prehospital thrombolysis of a pulmonary embolism with high vital risk is not the subject of any recommendation. We report the case of a severe shock related to a suspicion of pulmonary embolism with favourable issue after the administration of a thrombolytic drug in prehospital conditions. The evolution's speed and the constraints of mobilization resulted in choosing an aggressive therapeutic strategy after evaluation of the benefit/risk ratio made only on the clinical data.

Aged↗
PubMed2004

[National survey of emergency management of acute pain in prehospital setting].

OBJECTIVES: Assessment of skill of physicians staffed Mobile Intensive Care Units (MICU) in severe acute pain (SAP) management. METHODS: This study was conducted with a phone questionnaire addressed to emergency physicians of all metropolitan Smur (N =360). This questionnaire included medical teaching, professional position, means of severe acute pain assessment and definition of SAP, treatment, analgesic drug availability, locals guidelines and personal assessment of national guidelines were studied. RESULTS: Exhaustivity was more than 99% (359/360). Eighty percent of physicians were specialized in emergency care, 8% were anaesthesiologists (or intensivists), 78% worked in emergency department and 76% were full time. Forty nine percent of physicians did not know French Society of Anesthesiology and Intensive Care guidelines and 63% did not have locals analgesics guidelines. To define SAP, Visual Analogic Scale (VAS) or Numeric Scale (NS) >6/10 were mentioned only by 17%. Therapeutic efficiency was assessed and defined by VAS or NS <3/10 by 14%. Morphine was available in 90% of MICU, fentanyl in 79% and nalbuphine in 64%. Morphine was used in first intention by 71% of physicians. Guidelines about doses and waiting periods between 2 administrations were followed respectively by 6% and 28%. Ninety percent of physicians combined at least two treatments, 58 % combined at least three and 39%, at least four. CONCLUSION: This survey showed a low knowledge about severe acute pain management in out-of-hospital setting, both for pain assessment and treatment. There were few locals guidelines to overcome this deficiency. A training work is essential to improve care of acute pain in out-of-hospital setting.

Acute Disease↗
PubMed2004

N-acetyl functions and acetate detected by nuclear magnetic resonance spectroscopy of urine to detect renal dysfunction following aminoglycoside and/or glycopeptide antibiotic therapy.

BACKGROUND/AIMS: N-acetylneuraminidine (NeuNAc), N-acetylglutamine (GIcNAc) and acetate are metabolites present in normal urine. In patients treated with aminoglycosides and/or glycopeptides, elevation of these metabolites in urine suggests renal tubular injury. NeuNAc, GIcNAc and acetate are easily detected by magnetic resonance spectroscopy (MRS), in contrast to other bioanalytical methods. In the present study, these urinary metabolites were detected using MRS and compared with standard biochemical markers of renal injury in intensive care unit patients treated with aminoglycosides and/or glycopeptides. METHODS: 16 patients with clinical and biochemical signs of renal dysfunction were included in the study. Proton magnetic resonance spectra were obtained from 134 urine samples. The resonance intensity of NeuNAc, GIcNAc and acetate were reported relative to the resonance intensity of creatinine (ct). These ratios were compared with classical parameters of renal dysfunction, such as plasma creatinine and urea concentration, and 24-hour urine volume, by logistic regression and general linear models. RESULTS: Statistical analysis showed that changes in plasma creatinine and urea concentration were reliably reflected in changes in the NeuNAc/ct ratio, and that plasma urea concentration changes also correlated with the acetate/ct ratio; however, the GIcNAc/ct ratio was not related to these measures of overall renal function. CONCLUSIONS: NeuNAc/ct may be a useful marker of renal dysfunction in patients treated with aminoglycosides and glycopeptides; by MRS it can be both straightforward and informative to follow the renal function of patients treated with these antibiotics.

Acetates↗
PubMed2003

Stroke associated with pulmonary embolism after air travel.

Prolonged air travel is associated with an increased incidence of thromboembolic events. The occurrence of stroke was studied in patients with pulmonary embolism after air travel in a review of all flights arriving at Charles de Gaulle Airport in Paris during an 8-year period. Thromboembolic stroke and patent foramen ovale were diagnosed in four patients with pulmonary embolus.

Aerospace Medicine↗
PubMed2003

[Organization of medical rescue during catastrophes with limited effects occurring in urban areas].

OBJECTIVE: We conducted a survey regarding the organization of medical rescue during major events (catastrophes with limited effects) occurring in urban areas (Paris and immediate suburbs). The goal of this work was to study the availability of on site medical help and the real needs.Study design - Retrospective survey. METHODS: Thirty-eight major events were analysed between 1988 and 2000. The median number (25th-75th percentiles) of victims per event was 42 (21-68) (range 8 to 424). RESULTS: The median percentage of true emergencies (TE) was 5% with regard to the total number of victims per event. Thirty minutes after the event, 92% of the sites had a number of physician-manned ambulances greater than the number of severe victims. The median time to first evacuation was 79 (62-102) min. CONCLUSION: Disasters with limited effect occurrence in Paris and its immediate suburbs are characterized by a small percentage of TE and by a constant oversupply of medical means onsite. These observations led us to propose a new organization of medical rescue during this type of catastrophe, abandoning the classical notion of forward medical command post (FMCP) for a collection point of medical services (CPMS) consisting all means of evacuation (physician-manned and other ambulances). Also, a new type of victim identification, based on hospital base-station medical direction is discussed in this paper.

Aircraft↗
PubMed2003

[Automated external defibrillator use during cardiopulmonary resuscitation during flight].

Automated External Defibrillator (AED) during cardiopulmonary resuscitation should reduce mortality rate after out-of-hospital cardiac arrest. We report a case of defibrillation with AED during flight in a patient suffering cardiac arrest complicating an acute myocardial infarction. Two hours before landing, a 56-years-old man presented sudden cardiac arrest. Flight attendants performed basic cardiac life support, including AED. Five shocks were delivered. After landing, acute myocardial infarction was diagnosed and treated by prehospital thrombolysis and angioplasty with favorable outcome. AED is a crucial link of the chain of survival, especially where advance cardiac live support cannot be performed, like during flight. Despite an increasing AED availability, survival after cardiac arrest during flight remains exceptional.

Angioplasty, Balloon, Coronary↗
PubMed2003

Disposable laryngoscope blades do not interfere with ease of intubation in scheduled general anaesthesia patients.

BACKGROUND AND OBJECTIVE: Intubation of the trachea has been a risky cross-contamination procedure over the past decade because no perfect decontamination procedures exist. Infectious agents found on laryngoscopic devices have the potential for devastating spread of the human immunodeficiency virus, hepatitis viruses B and C and transmissible non-conventional agents. The purpose of this prospective observational study was to assess the quality of endotracheal intubation with disposable laryngoscope blades, under normal intubating conditions. METHODS: Anaesthetists were asked to complete daily questionnaires regarding the difficulty of intubation experienced using the Vital View disposable laryngoscope blade (Vital Signs Inc, Totowa, NC, USA). The choice of the type of blade (conventional or disposable blade) for the first attempt at intubation depended only on the operating room assignment. Glottic visualization during laryngoscopy was assessed by the modified Cormack and Lehane classification. Difficult tracheal intubation was evaluated by the intubation difficulty scale (> 5, procedure involving moderate to major difficulty). RESULTS: The anaesthetic staff recorded 219 intubations. One hundred-and-nineteen of first attempts at laryngoscopy were with disposable blades (DB group) and another 100 with conventional blades (CB group). There were no significant differences between the two groups for Cormack and Lehane score 3, for intubation difficulty scale scores > 5 and for intubation difficulty scale score 0. There were 12 blade changes before successful intubation. CONCLUSIONS: In routine use, the Vital View disposable laryngoscope blade appears to be an efficient device because it does not modify the ease of endotracheal intubation in most cases. Nonetheless, it may be advisable to maintain conventional laryngoscopes in reserve for difficult intubations.

Anesthesia, General↗
PubMed2002

[Pneumomediastinum as a complication of recreational ecstasy use].

Ecstasy recreational use dramatically increased during the last decade in France. Multiples complications associated with ecstasy consumption have been reported. We describe an exceptional case of pneumomediastinum related to ecstasy recreational use. The patient was a 19-year old patient whose medical history was significant for asthma and was a moderate tobacco smoker. He reported regular ecstasy recreational use. He presented at the emergency unit for chest pain and cough, 48 hours after the ingestion of three tablets of ecstasy and the inhalation of three other tablets. Blood pressure was 90/60 mmHg, pulse rate was 120 per minute, respiratory rate was 32 per minute and pulse oximetry was 93%. Neck emphysema was noted. Chest radiograph and scanner diagnosed pneumomédiastinum. Outcome was favorable with symptomatic treatment and the patient was discharged home eight days later. Pneumomediastinum is an exceptional complication after ecstasy recreational use. Physician should be aware of the risk of such event.

Adult↗
PubMed2002

Trends in opiate and opioid poisonings in addicts in north-east Paris and suburbs, 1995-99.

AIMS: (1). To assess the trends in the number, mortality and the nature of severe opiate/opioid poisonings from 1995 to 1999 in north-east Paris and adjacent suburbs and (2). to examine the effects of the introduction of high-dose buprenorphine on these parameters. DESIGN: Retrospective, 5-year study with review of pre-hospital, hospital and post-mortem data. SETTING AND PARTICIPANTS: Eighty patients from the toxicological intensive care unit (TICU) in north-east Paris, 421 patients from the pre-hospital emergency medical service in a north-east suburb of Paris (SAMU 93) and 40 deaths from the coroner's office in Paris. MEASUREMENTS AND RESULTS: We found that the number of pre-hospital opiate/opioid poisonings and deaths decreased over 5 years. During the same time frame, opiate/opioid poisoning admissions to our TICU remained steady, but the number of deaths declined. From 1995 to 1999, the detection of buprenorphine among opiate/opioid-poisoned TICU patients increased from two to eight occurrences per year while detection of opiates diminished from 17 to 10 occurrences per year. Increased buprenorphine detection correlated directly with increasing sales over this time period. In spite of the increased use of buprenorphine, the mortality associated with opiate/opioid poisonings has diminished in the pre-hospital environment from 9% in 1995 to 0% in 1999, and in the TICU from 12% in 1995 to 0% in 1997 and thereafter. We found a high frequency of multiple opiate/opioid use in severe poisonings, as well as the frequent association of other psychoactive drugs including ethanol. CONCLUSIONS: The number and the mortality of opiate/opioid poisonings appear to be stable or decreasing in our region. The association of multiple opiates/ opioids appears nearly as common as the association with other psychoactive drugs. The introduction of high-dose buprenorphine coincides with a decrease in opiate/opioid poisoning mortality. Further study will be necessary to clarify this observation.

Adult↗