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Abstract: Introduction: Non-invasive monitoring of oxygen saturation by pulse oxymetry (SpO2) is sometimes perturbed on fingers during shock states. Other sites are possible (toes, forehead, nose, ear). Self-adhesive standard digital sensors are commonly used off-label in these sites. We have assessed their reliability for all of these sites. Methods: We have studied patients presenting a stabilized shock state and receiving vasoconstrictive catecholamines. When an arterial blood gas was ordered, six SpO2 were measured quasi-simultaneously (self-adhesive standard sensors): right and left index, toe, forehead, nose and ear. SpO2 at “finger”, “toe”, “forehead”, “nose” and “ear” were compared to the arterial oxygen saturation (SaO2) by using the Bland and Altman method. The plethysmographic curve was assessed as “correct” or “unsatisfactory”. Results: Hundred and ten patients were included (63±15years, SAPSII 46±16, catecholamines: 0.6±0.5μg/kg/min). Plethysmographic curves are more often of “correct” quality for fingers (90%) than for the other locations (50 to 70%). Bias are low for all the locations (−0.1 to +1.5%). Limits of agreement are around ±5% for fingers and toes, but as high as ±15% for the face locations. When the analysis is restricted to plethysmographic curves of “good” quality, the limits of agreement are unchanged for fingers and toes, but improved (between ±5 to ±10%) for face locations. Conclusion: In patients with a shock receiving vasoconstrictive catecholamines, the reliability of SpO2 measurements with standard sensors appears better for fingers than for toes and face locations. These standard sensors should be discouraged for facial measurement because of their low reliability, even when the plethysmographic curve seems correct. Sensors specifically designed for each facial site exist, and their reliability should be estimated in patients receiving vasoconstrictive catecholamines. [Copyright &y& Elsevier]

Abstract: Introduction: Traumatic Subclavian Arterial Ruptures (TSCAR) are rare and with a poor prognosis. The aim of this study was to describe the epidemiological data and the medical charts of the initial care of each patient suffering a TSCAR following a traffic accident. Methods: Using the register of the road crash in the Rhone department (France) that records every casualty using the AIS codes, we retrospectively reviewed the prehospital and intrahospital medical, biological and radiological charts of every patient. Follow-up was obtained at day 60 post-trauma. Results: Among the 1181 severe traumatic injuries, five casualties have been recorded in the register with a TSCAR (0.4%). Four of the five patients died in an early dramatic fatal hemorrhagic shock. Similarities between casualties were observed for patients still alive at hospital arrival that associate 1) a two-wheel motorized rider (2-WMR) crashing without antagonist 2) a severe polytraumatism including thoracic and 3) orthopaedic lesions; 4) clinical and biological signs of a severe haemorrhagic shock; 5) radiological signs of scapulothoracic dissociation. Conclusion: TSCAR are rare with a high mortality. We recommend improving the early care by the recognition of the triad associating early severe shock, polytraumatism (thorax and superior limb) and radiological signs evocating scapulothoracic dissociation in a 2-WMR. These signs must lead to the operating theatre as fast as possible in association with early massive transfusions. [Copyright &y& Elsevier]

Abstract: Background: The cardiac output (CO) is classically measured in intensive care unit patients. pulse contour (PC) method allows monitoring of CO. Objective: The aim of the present study was to assess the ability of PC to assess the fluid responsiveness defined as an increase in CO more than or equal to 15% after 500mL hydroxyethyl starch over 20minutes. Patients and methods: In this observational prospective study, patients in shock in whom a PC method was inserted were included. CO was measure using the PC and thermodilution methods before and after a fluid challenge indicated by the physician. The correlation coefficient was measured, the diagram of Bland and Altman was built and the percentage of error (Critchley and Critchley method) was calculated. The ability of PC to diagnose fluid responsiveness was assessed using a receiver operating characteristics (ROC) curve. Results: Sixty-two fluid challenges were performed in 37 included patients. After fluid challenge, r2 was 0.05 (P <0.01), the bias between PC and thermodilution was 0.3±1.2L/min and the percentage of error was 36%. The area of the ROC curve was 0.601 [0.468–0.723]. Conclusion: In ICU patients with shock, PC cannot replace thermodilution to diagnose fluid responsiveness. [Copyright &y& Elsevier]

Copyright of IBS, Immuno-analyse & Biologie Specialisee 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.)

Abstract: Microcirculation represents a complex system devoted to provide optimal tissue substrates and oxygen. Therefore, pathophysiological and technological knowledge developments tailored for capillary circulation analysis should generate major advances for critically ill patients’ management. In the future, microcirculatory monitoring in several critical care situations will allow recognition of macro-microcirculatory decoupling, and, hopefully, it will promote the use of treatments aimed at preserving tissue oxygenation and substrate delivery. [Copyright &y& Elsevier]

Abstract: Arsenic (As) intoxication is nowadays extremely rare. Two cases of acute and chronic As criminal poisoning leading to death of a couple of retired people, are reported. Clinical presentation was simulating a gastro-enteritidis with fast evolution to refractory shock. Toxicological analysis confirmed this diagnostic, with respectively blood As concentrations at 579 and 21 765μg/l for our two patients. [Copyright &y& Elsevier]

Copyright of Pratique Medicale et Chirurgicale de l'Animal de Compagnie 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.)

Abstract: Objective: The aim of our work was to study cardiac sequelae of penetrating cardiac injuries. Material and methods: It is a retrospective study including nine patients (eight men and one woman with an average age of 26.6±7.4 years) hospitalised between January 1st, 1988 and December 31, 2002 in cardiovascular surgery department of Tunis Rabta hospital for heart wounds. Results: It was stab wounds in all patients. Heart lesions concerned primarily the right ventricle. In admission, two patients had cardiac tamponade and seven were in shock. Beating heart surgery without cardiopulmonary bypass in all patients performed surgical repair and it consisted in simple suture. Functional symptoms were observed in five patients at late outcome. Five patients had heart sequelae. It consisted of conduction abnormalities (right bundle branch block) in five patients. One patient had a small ventricular septal defect. Finally, partial permanent disability rates were less than 10%. Conclusion: Cardiac sequelae of penetrating cardiac wounds have good prognosis with the exception of a small partial permanent disability rate. Their prevention must be based on the fight against the urban violence and on the good initial management. [Copyright &y& Elsevier]

Abstract: Introduction: Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by recurrent spontaneous episodes of hypovolaemic shock due to marked plasma shifts from the intravascular to the extravascular space. It presents as the characteristic triad of hypotension, haemoconcentration and hypoalbuminemia. Case report: We describe a patient with SCLS with recurrent lipothymia who presented first with delayed oedema that was thought to be due to orlistat treatment. On the second episode the patient was seen with a pulmonary hypertension when plasma came back into vessels. On the third time the characteristic triad led to the diagnosis of SCLS. Discussion: SCLS should be considered in the differential diagnosis of recurrent hypovolemic shock without identifiable cause. Nevertheless, symptoms may be restricted to sole lipothymia or transient oedema or delayed hypoalbuminemia rendering the diagnosis difficult. [Copyright &y& Elsevier]

We report the case of a 47-year-old man who experienced a pulmonary embolism associated with a femoral thrombus after a traumatic intracranial haematoma and had caval interruption using a new generation endovascular percutaneous filter. A shock occurred soon after the procedure, associated with inferior cava system inflation related to a filter thrombosis. This is a rare complication since the cessation of surgical cava interruptions. The situation became stable after intensive volume expansion. This report underlines the risk of complication associated to vena cava interruption despite the use of new generation filters and the significance of mechanical measures in prevention of thrombosis when anticoagulants are contraindicated. [Copyright &y& Elsevier]