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Biomedical subjects

O Moeschler

Publications and source records attributed to O Moeschler.

26 records · Page 2Linked to original sources
PubMed1993

[Hospital management and short-term outcome of the severely injured: Lausanne experience].

Several physiological and anatomical methods of scoring severely injured patients have been developed since the 1970s, based on very large series of patients. In this study, 59 patients are assessed by the ISS (Injury Severity Score) and the RTS (Revised Trauma Score). The mean ISS is 28, and the mean RTS is 6; the overall evolution shows a 42.4% mortality. Analysis by the TRISS method shows 12 out of 18 "unexpected" deaths, the majority of which can be explained by the fact that the ISS underestimates severe neurological trauma, and that the RTS is not consistently obtained in the early patient notes in our emergency care system.

Adolescent↗
PubMed1992

[Anesthesia of patients with injury to the cervical spine].

This paper reviews the principal aspects of the immediate management of patients suffering from spinal injury. An understanding of the pathophysiology of primary and secondary spinal cord injury enables appropriate initial care to be provided, thereby avoiding exacerbation and/or progressive deterioration of the lesion. It includes protective measures, restoration of vital functions to maintain adequate tissue perfusion and oxygenation, as well as pharmacological prevention of secondary injury. Protective measures include proper immobilisation of the spine with a semi-rigid collar and tape on a long backboard, or on vacuum mattress, taking great care to avoid deleterious in-line compression forces on the spinal column. The combination of cervical spine instability, a full stomach, unopposed vagal reflexes, hypoxia and hypercarbia makes airway management of these patients difficult. Tracheal intubation under fibroscopic control, with insertion of the tube only after topical anaesthesia of the airways under titrated intravenous sedation, offers safety and comfort to the patient. However, in cases of severe deterioration of vital functions, intubation must be performed without any delay at the site of the accident or in the emergency room. Three options are available: blind naso-tracheal intubation with spontaneous breathing, modified rapid sequence induction with orotracheal intubation under double protection, and immediate surgical airway if these techniques fail. Patients with cervical spine injury may demonstrate severe hypotension requiring sympathomimetic agents and careful fluid loading to avoid pulmonary oedema. To prevent aggravation of the spinal cord injury by systemic factors, the goal of initial resuscitation is to restore an adequate perfusion pressure of at least 60 mmHg, a PaO2 > 100 mmHg, and to keep PaCO2 below 45 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Difficult aeromedical rescue situations: experience of a Swiss pre-alpine helicopter base.

Swiss Air Rescue (REGA) teams execute more than 3000 aeromedical missions annually, of which some require the use of a winch. To evaluate the need for early medical intervention at sites where landing is impossible, we analyzed retrospectively 100 consecutive operations (10.8% of all primary missions, 110 patients) accomplished by the REGA base at Lausanne with an emergency physician of the Centre Hospitalier Universitaire Vaudois (CHUV) on board. In such difficult rescue conditions, time to call, response times, and scene times were particularly long (mean delay to admission: 114 minutes). Fourteen patients were dead on arrival, 22 were uninjured, 50 had NACA Index 1-3 injuries (moderate), 22 had NACA Index 4-6 injuries (severe). Seventeen required major intervention at the site or during rescue. We conclude that in our European pre-alpine region 22% of patients rescued by winch are severely injured. Since rescue actions are particularly long and difficult, the performance of advanced procedures at the scene and during transportation is of great value.

Aircraft↗
PubMed1990

[Transportation of patients in the prehospital phase: education of physicians].

Pre-hospital emergency medicine is developing in Switzerland. At present, however, there is no training standard for this specific and sometimes confusing aspect of extra-hospital activity. Some of the training courses which exist in other countries are recalled and the number of emergency medical transportations in Switzerland is estimated. The training programs of fourteen Swiss hospitals which cooperate with ambulance or helicopter rescue services are then presented. An enquiry by the Centre Hospitalier Universitaire Vaudois (CHUV) among 46 physicians participating regularly in Swiss Air Rescue (REGA) helicopter operations shows the very varied pathology involved and the problems encountered in creating a training program of this kind.

Curriculum↗
PubMed1982

[Definition of apnea in the diagnosis of brain death].

Apnea is an essential criterion for the diagnosis of brain death and is often difficult to determine in artificially ventilated patients. Absolute apnea is the absence of respiration when the respiratory center is maximally stimulated by hypercapnia. In a study of 13 cases we show that measuring PaCO2, which must be equal or superior to 50 mm Hg, is mandatory in confirming the stimulation of the respiratory center. The duration of apnea necessary to reach this level is highly variable. It does not induce hypoxemia when the technique of apneic oxygenation is used.

Adolescent↗