Search

Abstract: Objectives: One objective is to state more accurately the difficulties met by the anaesthesiologists in an emergency context in case of withholding or withdrawing life sustaining therapies. Study design and participants: A questionnaire addressed to anaesthesiologists of nine hospitals in the extreme West part of France. Materials and methods: The questionnaires were sent and returned by mail in order to guarantee confidentiality. Results: The participation rate was 40% with 172 questionnaires analysed. Ninety-eight per cent of the anaesthesiologists have already participated in a withholding or withdrawing life sustaining treatments, and in an emergency context in 92% of the cases. In that last case, criteria related to the severity of the clinic presentation and to the short-term death probability influence the decision made to interrupt life-sustaining therapies. For 93% of anaesthesiologists, the decision should be collegial, but 50% of them had already made such a decision alone. The withdrawal of ventilatory support was the most difficult decision to make. Withdrawing mechanical ventilation or extubating appeared impossible for 23.4 and 50% of the anaesthesiologists respectively. Providing comfort care to the patients with end of life decision was essential for 100% of the anaesthesiologists, but 11% of them used and considered analgesic and sedation after withholding or withdrawing life sustaining treatments as euthanasia. The complaint possibility worried 57% of the anaesthesiologists and influenced the writing of the process or giving information to the families respectively for 65 and 75%. The righting of the medical files could be improved for 92% of the anaesthesiologists. Conclusion: The decision of withholding and withdrawing life sustaining treatments in an emergency context is based on the conviction of short-term death probability. Withholding and withdrawing life sustaining treatments is a decision made according to the principles of collegiality and necessary comfort cares, but the procedure can still be improved, especially in the redaction of the medical file and the ethical and juridical control of these extreme situations. [Copyright &y& Elsevier]

Abstract: Objective: Several studies have highlighted the assets of the influenza rapid diagnostic tests (IRDT) for the emergency department management of febrile children. The objective of this study was to determine in ambulatory pediatric setting impact of IRDT on the management of febrile children during an epidemic, especially on other diagnostic testing performed, antibiotic and antiviral treatments. Methods: During an influenza epidemic, 37 paediatricians in three different areas of France included all children presenting fever with respiratory illnesses; they performed IRDT (test QuickVue® for Influenza A and B, Quidel). Data collected were antiflu vaccination, previous asthma, symptoms, clinical signs, other diagnostic testing performed, and a follow-up two weeks later. Results: Between December, 2006 and April, 2007, 695 children entered the program. The average age of those children was 4.1 years old (SD 3.4), median 3.2 (0.07–17.5). In 41.6% of the cases, the tests proved positive. Among 13 symptoms of influenza, only five were significantly more present in the group IRDT+: shiver (68.1% versus 57.4%), asthenia (87% versus 79.9%), cough (87.5% versus 70.1%), rhinorrhea (93.4% versus 83.3%), and sleepiness (54.2% versus 43.4%). The number of laboratory tests and radiographs ordered were less frequent in group IRDT+ than in group IRDT-: respectively 0.7% versus 11.6%, and 0.7% versus 8.6% (p <0.0001). IRDT+ group received antibiotics in 7.6% of cases (22 patients, 20 for OMA) and antiviral in 64.7%. IRDT- group received respectively 18.5% antibiotics, and no antiviral (p <0.0001). Conclusion: This study confirms the difficulty of clinical influenza diagnosis, and suggests the assets of IRDT to diagnose influenza and to improve the management of influenza in ambulatory paediatric setting. [Copyright &y& Elsevier]

Abstract: Objective: The objective was to test the application of barrier precautions and hospital organization during an influenza pandemic, in accordance with the national program of influenza pandemic training and the “Influenza addendum” of the hospital guidelines in case of a major disaster. Method: A practical exercise was performed on December 18th 2007 in two areas of high viral density and one of low viral density. This exercise involved all the people in these areas, without disturbing the normal care activity. Results: Two hundred and forty-five people were evaluated. Seventy-five per cent of whom had been trained in the hospital. Hand hygiene complied with pre-established procedures in 32% of cases, was acceptable in 44%, and deficient in 24%. Surgical mask application was unacceptable in 21% of cases. These precautions were well accepted by 36% of the personnel, accepted by 54%, and a burden for 10%. The poor sealing capacity of mask FFP2 (national allocation), depending on facial features, its poor tolerance, the lack of water stations, and the presence of groups of people were all noted. Conclusion: This exercise was rated as satisfactory with a good participation. However, it revealed unexpected dysfunctions such as application of barrier precautions. Also, that the FFP2 mask was not suitable for all people, especially for children, a problem in case of a pandemic. Finally, this exercise should lead to corrective actions and to completing the various training sessions initiated in other institutions. [Copyright &y& Elsevier]

Copyright of EMC-Medecine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Medecine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

As in the case of adults, there are three main goals in the monitoring of severe head trauma in children: to prevent or minimize the apparition of secondary lesions, to optimize treatment, to help make precise prognosis.The basic monitoring is composed of repeated clinical examinations, brain radiological imaging and control of vital parameters (blood pressure, temperature, PaO2 (SpO2), PaCO2 (FETCO2), haemoglobin, haematocrit. On the other hand, during specific brain monitoring, the brain perfusion (TCD, intracranial pressure), the electrical activity of the brain and sometimes the brain oxygenation (SvjO2) are controlled. The data obtained from the brain monitoring must always be interpretated carefully. A child with a severe head trauma, in ICU, always requires constant and competent medical attention. [Copyright &y& Elsevier]

The initial management of severely head-injured patients, including infants and children, is aimed at preventing and treating secondary brain damage, which mainly result from systemic insults (hypoxaemia, hypercarbia, arterial hypotension). Orotracheal intubation, followed by continuous sedation-analgesia, is mandatory when the Glasgow Coma Scale score (GCS) is less than or equal to 8 (crush induction is recommended). The goal of mechanical ventilation is to maintain normoxaemia and normocarbia. Moreover, the maintenance of an optimal cerebral perfusion pressure, usually 50 mmHg in infants, requires volume loading (isotonic fluids and colloids), and catecholamines if arterial hypotension persists. Intravenous mannitol is used only in case of life threatening intracranial hypertension, keeping in mind the potential for aggravating an hypovolaemia. Cerebral tomodensitometry is the most relevant imaging procedure for diagnosing surgical brain lesion. However, it should be noted, that severe head trauma is frequently associated with extra-cranial traumatic injuries, which may be responsible for (avoidable) deaths if the diagnosis is not made or delayed. Therefore, infants and small children presenting with severe head trauma should be considered as multiple injured and treated accordingly. Adequate initial management of severely head-injured children may participate to improved neurological outcome. [Copyright &y& Elsevier]

Les attentats de Paris et Nice ont conduit à réviser les procédures de Plan Blanc concernant notamment la délivrance des PSL aux services d'urgence. Une étude pilote a été menée conjointement avec le CHU de Besançon. Sur 15 mois, 8 réunions se sont tenues en présence des responsables de la qualité du CHU, l'hémovigilance du CHU et la responsable de la délivrance l'EFS, afin de définir les modalités les plus appropriées. La distinction entre Plan Blanc attentat et Plan Blanc hors attentat a été réalisée. Deux lignes du dispositif automatisé sur les 3 existantes ont été dédiées au plan blanc desservant le lieu de prise en charge des urgences absolues et des extrêmes urgences. La 3e ligne sera réservée aux urgences transfusionnelles des autres services de soins pendant toute la durée du Plan Blanc. La prescription simplifiée de PSL, normalement réservée au pré hospitalier, a été étendue aux services de réanimation médicale et chirurgicale et SSPI. Dans les deux types de Plan Blanc, un personnel de l'EFS sera intégré au PC du CHU, afin de renseigner l'EFS sur les victimes et anticiper sur les besoins. Les procédures dégradées en cas de panne du pneumatique ont été décrites. Cette procédure est issue d'une analyse commune qui a permis la gestion de l'interface et de disposer des autorisations préalables qui ont été présentées à l'ensemble des soignants et intégrées dans les procédures du CHU. Ce travail préalable a permis de réviser nos procédures Plan Blanc et de les tester à travers des exercices impliquant l'ensemble des acteurs dans le but de garantir la sécurité transfusionnelle des patients. [ABSTRACT FROM AUTHOR]

Abstract: The code de santé publique imposes to all health professionals an obligation to declare serious and undesirable events following cares applied during treatment investigations or prevention actions. An experimentation has been installed under the responsibility of the Institut de Veille sanitaire further to the 9 August 2004 bill. It aims to define how to declare undesirable adverse events to test its feasibility, its efficiency and to identify the necessary conditions to widespread its modalities. The field of these experimentations concerns all health professionals, working in public hospital or in private practice. The definition of undesirable adverse events should be clarified. Different ways to declare these events will be discussed with SFRO (Société française de radiothérapie oncologique) to improve the current management of incidents and adverse events. [Copyright &y& Elsevier]

Abstract: The authors report the case of a 23 year old patient, who presented the following combination of injuries after a fall, namely a divergent dislocation of the elbow, a fracture of the radial head, a fracture of the ulna and a perilunate dislocation with scaphoid fracture. The entire injury thus represented a bipolar dislocation of the forearm. The emergency management consisted of a closed reduction of the elbow together with osteosynthesis of the ulna, internal fixation of the scaphoid with a compression screw, and scaphocapitate K wiring. After 26 months, the function of the elbow was satisfactory, and the range of motion of the wrist was from 50° of flexion to 40° of extension. Satisfactory healing of the scaphoid was observed. This combination of injuries has only rarely been reported in the literature. [Copyright &y& Elsevier]