25 results on '"TAZAROURTE, K."'
Search Results
2. Association Between Emergency Medical Services Intervention Volume and Out-of-Hospital Cardiac Arrest Survival: A Propensity Score Matching Analysis.
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Vincent T, Lefebvre T, Martinez M, Debaty G, Noto-Campanella C, Canon V, Tazarourte K, and Benhamed A
- Abstract
Background: Out of hospital cardiac arrest (OHCA) survival rates are very low. An association between institutional OHCA case volume and patient outcomes has been documented. However, whether this applies to prehospital emergency medicine services (EMS) is unknown., Objectives: To investigate the association between the volume of interventions by mobile intensive care units (MICU) and outcomes of patients experiencing an OHCA., Methods: A retrospective cohort study including adult patients with OHCA managed by medical EMS in five French centers between 2013 and 2020. Two groups were defined depending on the overall annual numbers of MICU interventions: low and high-volume MICU. Primary endpoint was 30-day survival. Secondary endpoints were prehospital return of spontaneous circulation (ROSC), ROSC at hospital admission and favorable neurological outcome. Patients were matched 1:1 using a propensity score. Conditional logistic regression was then used., Results: 2,014 adult patients (69% male, median age 68 [57-79] years) were analyzed, 50.5% (n = 1,017) were managed by low-volume MICU and 49.5% (n = 997) by high-volume MICU. Survival on day 30 was 3.6% in the low-volume group compared to 5.1% in the high-volume group. There was no significant association between MICU volume of intervention and survival on day 30 (OR = 0.92, 95%CI [0.55;1.53]), prehospital ROSC (OR = 1.01[0.78;1.3]), ROSC at hospital admission (OR = 0.92 [0.69;1.21]), or favorable neurologic prognosis on day 30 (OR = 0.92 [0.53;1.62])., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2024
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3. A Time-Dependent Propensity Score Matching Approach to Assess Epinephrine Use on Patients Survival Within Out-of-Hospital Cardiac Arrest Care.
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Baert V, Hubert H, Chouihed T, Claustre C, Wiel É, Escutnaire J, Jaeger D, Vilhelm C, Segal N, Adnet F, Gueugniaud PY, Tazarourte K, Mebazaa A, Fraticelli L, and El Khoury C
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- Epinephrine therapeutic use, Humans, Propensity Score, Registries, Treatment Outcome, Cardiopulmonary Resuscitation, Emergency Medical Services, Out-of-Hospital Cardiac Arrest drug therapy
- Abstract
Background: Epinephrine effectiveness and safety are still questioned. It is well known that the effect of epinephrine varies depending on patients' rhythm and time to injection., Objective: We aimed to assess the association between epinephrine use during out-of-hospital cardiac arrest (OHCA) care and patient 30-day (D30) survival., Methods: Between 2011 and 2017, 27,008 OHCA patients were included from the French OHCA registry. We adjusted populations using a time-dependent propensity score matching. Analyses were stratified according to patient's first rhythm. After matching, 2837 pairs of patients with a shockable rhythm were created and 20,950 with a nonshockable rhythm., Results: Whatever the patient's rhythm (shockable or nonshockable), epinephrine use was associated with less D30 survival (odds ratio [OR] 0.508; 95% confidence interval [CI] 0.440-0.586] and OR 0.645; 95% CI 0.549-0.759, respectively). In shockable rhythms, on all outcomes, epinephrine use was deleterious. In nonshockable rhythms, no difference was observed regarding return of spontaneous circulation and survival at hospital admission. However, epinephrine use was associated with worse neurological prognosis (OR 0.646; 95% CI 0.549-0.759)., Conclusions: In shockable and nonshockable rhythms, epinephrine does not seem to have any benefit on D30 survival. These results underscore the need to perform further studies to define the optimal conditions for using epinephrine in patients with OHCA., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2020
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4. Access to treatment among persons with hemophilia: A spatial analysis assessment in the Rhone-Alpes region, France.
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Leroy V, Freyssenge J, Renard F, Tazarourte K, Négrier C, and Chamouard V
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- Adult, Female, France, Geographic Information Systems, Humans, Male, Spatial Analysis, Blood Coagulation Factors administration & dosage, Health Services Accessibility, Hemophilia A therapy, Pharmacy Service, Hospital statistics & numerical data
- Abstract
Objectives: In France, only hospital pharmacies can dispense clotting factor concentrates to persons with hemophilia, which limits the access to care for the treatment and the prevention of bleeding episodes. Moreover, the cost of clotting factor concentrates may restrain the maintenance of sufficient stocks in hospital pharmacies. The aim of this study was to investigate the accessibility of clotting factor concentrates to persons with hemophilia in the context of long-term prophylaxis and emergency treatment in the Rhone-Alpes region of France., Methods: A geographic information system was used for evaluating accessibility of clotting factor concentrates. Persons with hemophilia and hospital pharmacies were geolocalized with the use of postal data, and the evaluation of accessibility was based on the road network., Results: Approximately 72% of the study area was accessible in less than 30 minutes to a hospital pharmacy. Eighty-five percent of persons with hemophilia had access to clotting factor concentrates for prophylactic treatment in less than 20 minutes. Most of them were patients with severe or moderate hemophilia. Regarding emergency doses, factor VIII was accessible in less than 30 minutes in 45.6% of the study area, and factor IX in 30.5%., Conclusion: This study highlights that spatial access to clotting factor concentrates by persons with hemophilia in the Rhône-Alpes region is good for prophylactic treatment but is more uneven for emergency doses., (Copyright © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)
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- 2019
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5. 'Read-and-do' response to a digital cognitive aid in simulated cardiac arrest: the Medical Assistance eXpert 2 randomised controlled trial.
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Donzé P, Balanca B, Lilot M, Faure A, Lecomte F, Boet S, Tazarourte K, Sitruk J, Denoyel L, Lelaidier R, Lehot JJ, Rimmelé T, and Cejka JC
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- Anesthesiology education, Checklist methods, Cognition, Humans, Internship and Residency, Cardiopulmonary Resuscitation methods, Checklist instrumentation, Clinical Competence statistics & numerical data, Heart Arrest therapy, Mobile Applications, Patient Simulation
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- 2019
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6. [Impact of the 2009 Afssaps guidelines on the management of venous thromboembolic disease in emergency department: Before/after study].
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De Massari L, Jamilloux Y, Lega JC, Sigal A, Jacob X, Tazarourte K, Mensah K, and Sève P
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- Aged, Emergency Medical Services methods, Emergency Medical Services standards, Emergency Medical Services statistics & numerical data, Female, France epidemiology, Guideline Adherence statistics & numerical data, Humans, Male, Middle Aged, Patient Safety standards, Public Health Administration standards, Retrospective Studies, Societies, Medical, Venous Thromboembolism epidemiology, Emergency Service, Hospital standards, Practice Guidelines as Topic, Venous Thromboembolism therapy
- Abstract
Introduction: The French Agency for Health Safety of Products published recommendations of good practices (RGP) for the treatment of venous thromboembolic disease in 2009. Four of these recommendations apply to the initial management of the disease, with the objective of this study is to determine whether the development and diffusion of the four RGP has had an impact on the practice., Methods: A retrospective before/after study comparing 132 patients treated in emergency department of the Civil Hospices of Lyon for pulmonary embolism (PE) and/or deep venous thrombosis (DVT) in 2008-2009 ("before") and 153 patients in 2010-2011 ("after")., Results: In the "before" period, 70 patients were treated for DVT and 62 patients for PE. In the "after" period, 50 patients were treated for DVT and 103 patients for PE. The compliance rate was not significantly different for the two periods for each RGP except for the indication of low molecular weight Heparin (LMWH) or fondaparinux in the absence of severe renal failure (21% "before" vs. 45% "after"; P=0.02) for patients with PE. Management for the four recommendations was conform for 5.6% of eligible patients in the "before" period and for 3.7% for the "after" period., Conclusion: Our study shows that globally there is no impact of RGP. The reasons appear multiple with first, the mere dissemination and the absence of implementation of these guidelines., (Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.)
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- 2018
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7. Evolution of Survival in Cardiac Arrest with Age in Elderly Patients: Is Resuscitation a Dead End?
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Segal N, di Pompéo C, Escutnaire J, Wiel E, Dumont C, Castra L, Tazarourte K, El Khoury C, Gueugniaud PY, and Hubert H
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- Aged, Aged, 80 and over, Cohort Studies, Female, France, Humans, Linear Models, Male, Registries statistics & numerical data, Resuscitation methods, Retrospective Studies, Survival Analysis, Time Factors, United States, Age Factors, Out-of-Hospital Cardiac Arrest mortality, Resuscitation standards
- Abstract
Background: Even if age is not considered the key prognostic factor for survival in cardiac arrest (CA), some studies question whether cardiopulmonary resuscitation (CPR) in the elderly could be futile., Objective: The aim of this study was to describe differences in out-of-hospital CA survival rates according to age stratification based on the French National CA registry (RéAC). The second objective was to analyze the differences in resuscitation interventions according to age., Methods: We performed a retrospective cohort study based on data extracted from the RéAC. All 18,249 elderly patients (>65 years old) with non-traumatic CA recorded between July 2011 and March 2015 were included. Patients' ages were stratified into 5-year increments., Results: Cardiopulmonary resuscitation (CPR) was started significantly more often in younger patients (p = 0.019). Ventilation and automated external defibrillation by bystanders were started without any difference between age subgroups (p = 0.147 and p = 0.123, respectively). No difference in terms of rate of external chest compressions or ventilation initiation was found between the subgroups (p = 0.357 and p = 0.131, respectively). Advanced cardiac life support was started significantly more often in younger patients (p = 0.023). Total CPR duration, return of spontaneous circulation, and survival at hospital admission and at 30 days or hospital discharge decreased significantly with age (p < 10
-3 ). The survival decrease was linear, with a loss of 3% survival chances each 5-year interval., Conclusions: This study found that survival in older persons decreased linearly by 3% every 5 years. However, this diminished rate of survival could be the consequence of a shorter duration and less advanced life support., (Copyright © 2017 Elsevier Inc. All rights reserved.)- Published
- 2018
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8. French regional trauma network: the Rhone-Alpes example.
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Bouzat P, David JS, and Tazarourte K
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- France, Humans, Triage, Regional Medical Programs organization & administration, Trauma Centers organization & administration
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- 2015
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9. [Storing succinylcholine in prehospital settings following the recommendations of the French National Agency for the safety of medicines].
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Lefort H, Mendibil A, Margerin S, Cuquel AC, Jost D, Tazarourte K, Domanski L, and Tourtier JP
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- Cold Temperature, Drug Packaging, Drug Stability, Drug Storage, Health Care Surveys, Humans, Refrigeration standards, Safety, Emergency Medical Services, Neuromuscular Depolarizing Agents chemistry, Succinylcholine chemistry
- Abstract
Objective: The French National Pharmaceuticals Agency (ANSM) has recommanded in July 2012 not to break the cold chain before using succinylcholine (Celocurine®)., Research Objective: to understand the pre-clinical evolution of the conservation modes of this curare., Research Type: Descriptive study before (year 2011) and after (year 2012)., Patients and Method: Online survey to French Samu/Smur., Data Collected: SMUR location, conservation method at clinical base, in the mobile unit (UMH) and at the patient. Principal decision criteria: evolution of the conservation modes before and after the recommendation (qualitatives variables compared with a Fisher test)., Results: Out of 101 SAMU/SMUR, 62 answered. Conservation modes of succinylcholine vials were significantly different (P<0.001). Proper conservation was observed in 26 % of the cases before and 43 % after. Mobile units (UMH) equipped with a fridge increased from one out of two to 77 %. The lack of conservation modes passive or active on UMH went from 31 % to 3.4 % with isotherms bags with ice when a fridge was not available. The destruction of capsules at current temperature in a 24-hour period increased: 22 % before, 47 % after (P=0.04)., Conclusion: After recommendations from ANSM, conservation modes and destruction of succinylcholine in a prehospital environment were significantly impacted., (Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)
- Published
- 2014
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10. [Penetrating neck injuries: importance of one systematic clinical examination associated with a MDCT angiography].
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Lefort H, Cesareo E, Domanski L, Tourtier JP, and Tazarourte K
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- Adolescent, Angiography, Humans, Male, Tomography, X-Ray Computed, Neck Injuries diagnosis, Wounds, Penetrating diagnosis
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- 2014
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11. The concept of damage control: extending the paradigm in the prehospital setting.
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Tourtier JP, Palmier B, Tazarourte K, Raux M, Meaudre E, Ausset S, Sailliol A, Vivien B, Domanski L, and Carli P
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- Blood Transfusion, General Surgery organization & administration, Hemorrhage therapy, Hemostasis, Hemostatics therapeutic use, Humans, Hypothermia therapy, Military Medicine, Resuscitation, Tourniquets, Wounds and Injuries surgery, Emergency Medical Services organization & administration, Wounds and Injuries therapy
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Objective: The purpose of this review is to present the progressive extension of the concept of damage control resuscitation, focusing on the prehospital phase., Article Type: Review of the literature in Medline database over the past 10 years., Data Source: Medline database looking for articles published in English or in French between April 2002 and March 2013. Keywords used were: damage control resuscitation, trauma damage control, prehospital trauma, damage control surgery. Original articles were firstly selected. Editorials and reviews were secondly studied., Data Synthesis: The importance of early management of life-threatening injuries and rapid transport to trauma centers has been widely promulgated. Technical progress appears for external methods of hemostasis, with the development of handy tourniquets and hemostatic dressings, making the crucial control of external bleeding more simple, rapid and effective. Hypothermia is independently associated with increased risk of mortality, and appeared accessible to improvement of prehospital care. The impact of excessive fluid resuscitation appears negative. The interest of hypertonic saline is denied. The place of vasopressor such as norepinephrine in the early resuscitation is still under debate. The early use of tranexamic acid is promoted. Specific transfusion strategies are developed in the prehospital setting., Conclusion: It is critical that both civilian and military practitioners involved in trauma continue to share experiences and constructive feedback. And it is mandatory now to perform well-designed prospective clinical trials in order to advance the topic., (Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)
- Published
- 2013
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12. The initial management of trauma patients is an especially relevant setting to evaluate professional practice patterns.
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Harrois A, Mertes PM, Tazarourte K, Atchabahian A, Duranteau J, Langeron O, and Vigué B
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- Data Collection, Humans, Patient Care Management, Practice Patterns, Physicians', Professional Practice organization & administration, Wounds and Injuries therapy
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The initial management of trauma patients in a dedicated location is a crucial step in the treatment of these patients. The characteristics of this phase are such that they meet all the criteria for a professional practice patterns evaluation (PPPE or PPE): formalized protocols, clear-cut timeframes, specific roles of different stakeholders, and multidisciplinary medical and paramedical team. In addition, the expected result of the PPE approach, improved care, will have a direct impact on patient outcomes. This PPE modeled on an audit aims at evaluating the care process based on representative criteria. These criteria should include: the planned structure and organization; the protocols; the strategy and time frames for procedure implementation; the relationships between stakeholders; the results. For each criterion, differences between the expected characteristics and the observed reality are analyzed. The prospective (independent observer or video) and/or retrospective (records, register) collection of data during 20 consecutive encounters should be sufficient to identify dysfunctions and provide guidance on the changes that need to be implemented. The proposed data collection form includes 15 items representative of the five defined criteria. These items often describe departmental choice. The pursuit of quality is defined first in terms of medical and paramedical results, but also in administrative and financial terms. Following the analysis produced by a representative group of actors, a multidisciplinary discussion of the results should be followed by proposals for simple changes approved by everyone. After a few months of implementation, the impact of the proposed improvement measures will be assessed by a new survey. This approach, in addition to improving the quality of care, allows better team stress management and greater work enjoyment., (Copyright © 2013. Published by Elsevier SAS.)
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- 2013
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13. Update on prehospital emergency care of severe trauma patients.
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Tazarourte K, Cesaréo E, Sapir D, Atchabahian A, Tourtier JP, Briole N, and Vigué B
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- Accident Prevention, Aircraft, Cost-Benefit Analysis, Humans, Injury Severity Score, Patient Admission, Prognosis, Resuscitation, Trauma Centers organization & administration, Trauma Centers trends, Trauma Severity Indices, Triage, Emergency Medical Services trends, Wounds and Injuries therapy
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The prognosis of severe trauma patients is determined by the ability of a healthcare system to provide high intensity therapeutic treatment on the field and to transport patients as quickly as possible to the structure best suited to their condition. Direct admission to a specialized center ("trauma center") reduces the mortality of the most severe trauma at 30 days and one year. Triage in a non-specialized hospital is a major risk of loss of chance and should be avoided whenever possible. Medical dispatching plays a major role in determining patient care. The establishment of a hospital care network is an important issue that is not formalized enough in France. The initial triage of severe trauma patients must be improved to avoid taking patients to hospitals that are not equipped to take care of them. For this purpose, the MGAP score can predict severity and help decide where to transport the patient. However, it does not help predict the need for urgent resuscitation procedures. Hemodynamic management is central to the care of hemorrhagic shock and severe head trauma. Transport helicopter with a physician on board has an important role to allow direct admission to a specialized center in geographical areas that are difficult to access., (Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)
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- 2013
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14. Head injury with unilateral optic nerve enlargement: Could it be caused by increased intracranial pressure?
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Tourtier JP, Lemoullec D, and Tazarourte K
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- Fractures, Comminuted complications, Fractures, Comminuted pathology, Humans, Optic Nerve Injuries etiology, Optic Nerve Injuries pathology, Intracranial Hypertension, Optic Nerve pathology
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- 2011
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15. [ST-segment elevation acute coronary syndromes: Prehospital management strategies].
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Petrovic T, Tazarourte K, Lapandry C, Adnet F, and Lapostolle F
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- Acute Coronary Syndrome physiopathology, Humans, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome therapy, Emergency Medical Services
- Abstract
Prehospital management of ST-segment elevation myocardial infarction is a complex issue. Many components are involved, beginning with information of the public on the symptoms of heart attack, up to the choice of the final pathway and destination of the patients, with many intermediate steps including the regulation of emergency calls, the implementation of optimal diagnostic strategies, the choice of reperfusion therapy and of adjuvant medications. In recent years, optimization of these different components has led to improved patients' outcomes in this still life-threatening condition., (Copyright © 2010. Published by Elsevier SAS.)
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- 2010
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16. Occlusion and malposition of small-bore chest tubes for pleural infection.
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Atchabahian A, Laplace C, and Tazarourte K
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- Bacterial Infections diagnosis, Equipment Design adverse effects, Humans, Pleurisy diagnosis, Pleurisy etiology, Bacterial Infections therapy, Chest Tubes adverse effects, Pleurisy therapy
- Published
- 2010
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17. Do we follow triage protocols?
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Tourtier JP, Tazarourte K, Lemoullec D, and Auroy Y
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- Humans, Injury Severity Score, Trauma Centers, Wounds and Injuries epidemiology, Emergency Service, Hospital organization & administration, Triage methods, Wounds and Injuries classification
- Published
- 2010
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18. [Prehospital management of severe preeclampsia].
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Trabold F and Tazarourte K
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- Adult, Female, Humans, Monitoring, Physiologic, Pregnancy, Transportation of Patients, Emergency Medical Services, Pre-Eclampsia therapy
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Prior to transport, agreement must be reached among all the senior medical staff members involved in the transfer. Tight clinical surveillance is necessary during the transport. The aim of the pharmacological control of a severe hypertension is to allow a moderate reduction of the mean arterial blood pressure as well as dampening the large pressure variations. Boluses of calcium channel inhibitors, eventually combined with labetalol, are to be used as first line treatment. Systematic fluid expansion prior to admission is not recommended. However, it is indicated if obvious signs of hypovolaemia are present, such as a sudden drop in blood pressure, secondary to the initiating of an antihypertensive therapy. It is possible to use i.v. benzodiazepines for the treatment of eclampsia in the prehospital setting. If magnesium sulfate therapy has been initiated in a preeclamptic woman with neurological signs, it may be continued during her transport., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)
- Published
- 2010
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19. [Etomidate and sepsis: an accusation without proof, a proceeding with no victim].
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Césaréo E, Tazarourte K, and Dékadjévi H
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- Humans, Etomidate adverse effects, Hypnotics and Sedatives adverse effects, Sepsis complications
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- 2007
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20. [Does cerebral salt wasting syndrome exist?].
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Leblanc PE, Cheisson G, Geeraerts T, Tazarourte K, Duranteau J, and Vigué B
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- Adrenal Cortex Hormones therapeutic use, Blood Pressure, Brain Diseases drug therapy, Brain Diseases epidemiology, Brain Diseases physiopathology, Diagnosis, Differential, Humans, Hyponatremia drug therapy, Hyponatremia epidemiology, Hypovolemia drug therapy, Hypovolemia epidemiology, Inappropriate ADH Syndrome drug therapy, Inappropriate ADH Syndrome epidemiology, Inappropriate ADH Syndrome physiopathology, Incidence, Urea therapeutic use, Brain Diseases etiology, Hyponatremia physiopathology, Hypovolemia physiopathology, Natriuresis
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Increased natriuresis is a frequent situation after subarachnoid haemorrhage (SAH). It may be responsible for hyponatremia, which can be dangerous in case of severe hypo-osmolarity or hypovolemia. Inappropriate secretion of antidiuretic hormone or cerebral salt wasting syndrome (CSWS) have been incriminated for hyponatremia after SAH, but it remains difficult to distinguish between both syndromes. There are many explanations for increased natriuresis after SAH, depending on the level of blood pressure, the volemia, and the presence or not of natriuretic peptides. The cerebral insult and the treatments, which are done to fight against elevated intracranial pressure or vasospasm, can modify any of these parameters. So it appears that the word "cerebral" in CSWS is probably not a good term and it would be better to talk about appropriate or non-appropriate natriuretic response. Corticoïds or urea can be useful for controlling hypernatriuresis.
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- 2007
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21. [Intracerebral monitoring of a patient with vasopasm].
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Geeraerts T, Leblanc PE, Dufour G, Tazarourte K, Duranteau J, and Vigué B
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- Brain Ischemia physiopathology, Humans, Intracranial Pressure, Jugular Veins physiopathology, Monitoring, Physiologic, Oxygen blood, Partial Pressure, Tomography, Emission-Computed, Single-Photon, Brain Ischemia diagnosis, Cerebrovascular Circulation physiology, Vasospasm, Intracranial physiopathology
- Abstract
Delayed neurological deficit occurs among 30% of patients after aneurysmal subarachnoid haemorrhage, mainly related to cerebral vasospasm. The early detection of cerebral ischemia remains problematic. Conventional cerebral monitoring (as intracranial pressure and cerebral perfusion pressure) appears to be insufficient, because cerebral ischemia may occur without elevated intracranial pressure. Global cerebral monitoring as venous jugular oxygen saturation are useful for regional monitoring. Local monitoring as oxygen tissue partial pressure (PtiO2) and microdialysis are sensible for brain ischemia detection, but may also ignore episodes occurring in non-monitored brain area. For the detection of most episodes of brain ischemia, several monitoring system should be use performing a multimodal intracerebral monitoring. Brain microdialysis and oxygen tissue partial pressure are promising monitoring system.
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- 2007
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22. [Early diagnostic for vasospasm after aneurysmal subarachnoid haemorrhage].
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Piednoir P, Geeraerts T, Leblanc PE, Tazarourte K, Duranteau J, and Vigué B
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- Cerebral Angiography, Cerebral Arteries pathology, Cerebral Arteries physiopathology, Humans, Reproducibility of Results, Sensitivity and Specificity, Ultrasonography, Doppler, Transcranial, Vasospasm, Intracranial diagnosis, Vasospasm, Intracranial diagnostic imaging, Vasospasm, Intracranial mortality, Intracranial Aneurysm complications, Subarachnoid Hemorrhage complications, Vasospasm, Intracranial etiology
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Vasospasm is the leading cause of sequelae or deaths after aneurysmal subarachnoid haemorrhage. Vasospasm occurs 2-10 days after haemorrhage and that justifies close monitoring during this period. Because clinical signs appear often to late to reverse ischaemia, paraclinic tools have been developed. Arteriography is the historical gold standard for diagnosis but no clear validated rules exist to measure vessel sections. Diagnosis of vasospasm is, thus, relatively subjective and only reflects one moment of arteries status. Transcranial doppler is a non-invasive and easily repeatable method but sensibility and specificity for vasospasm diagnosis are low compared to arteriography. However, day-to-day changes of arterial blood cells velocities can help to determine vasospasm risk and/or indicate time for arteriography. CT-scanner, PET-scan or IRM can help to evaluate ratio between perfusion and metabolism. Nevertheless, as arteriography, it is only a one-time measurement without control of treatment effects. Waiting for improvement of diagnosis techniques, arteriography stays the gold standard. To choose the right moment for invasive methods, intensivists need to use clinical and transcranial doppler data and start treatment as early as possible to be efficacious.
- Published
- 2007
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23. [Benefit of pharmaceutical anti-oedematous treatment in acute adult epiglottitis].
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Templier F, Lentz T, Tazarourte K, Coninx P, and Fletcher D
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- Acute Disease, Epinephrine administration & dosage, Humans, Infections complications, Injections, Intravenous, Male, Middle Aged, Nebulizers and Vaporizers, Treatment Outcome, Adrenal Cortex Hormones therapeutic use, Epiglottitis drug therapy, Epinephrine therapeutic use
- Abstract
Acute adult epiglottitis is a potentially life threatening infectious and respiratory emergency as it may result in airway obstruction. Endotracheal intubation, if needed, is a highly risky option in this situation and responsible for important morbidity and mortality rate. The option of a pharmaceutical anti-oedematous treatment, in order to avoid the risks involved in the endotracheal route has rarely been described. We here report the case of a 50-year-old man with a serious acute infectious epiglottitis who was treated at home by a Mobile Intensive Care Unit where a treatment of nebulized epinephrine and intravenous steroids was undoubtedly a successful option to the endotracheal route. So that, for adult patients and in the absence of any risk of an imminent respiratory arrest, this anti-oedematous treatment should be considered in order to avoid endotracheal route, an option which should be undertaken in case of complications. Nevertheless, this isolated case study concerning an adult is not transposable to children for which airway obstruction tolerance is lower.
- Published
- 2004
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24. [Medical prehospital rescue in head injury].
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Rouxel JP, Tazarourte K, Le Moigno S, Ract C, and Vigué B
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- Adult, Aged, Blood Gas Analysis, Blood Pressure physiology, Craniocerebral Trauma complications, Craniocerebral Trauma mortality, Female, France, Glasgow Coma Scale, Humans, Hypotension etiology, Hypotension therapy, Hypoxia etiology, Hypoxia therapy, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Craniocerebral Trauma therapy, Emergency Medical Services
- Abstract
Objective: To evaluate the effectiveness of prehospital medical care in head-injured patients., Patients and Methods: All head-injured patients admitted in Bicêtre hospital from 1995 to 1999 were retrospectively studied. Glasgow Coma Scale (GCS) score, mean arterial pressure (MAP) and SpO(2) measured on the field were compared to GCS, MAP and SpO(2) on arrival in the hospital. All treatments given during transport and first data recorded in the hospital were noted. Each parameter was compared to outcome at 6 months. Then, significant parameters were compared with a multivariate analysis., Results: Three hundred and four patients were included, 80% had a GCS
- Published
- 2004
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25. [Tracheal intubation in prehospital resuscitation: importance of rapid-sequence induction anesthesia].
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Cantineau JP, Tazarourte K, Merckx P, Martin L, Reynaud P, Berson C, Bertrand C, Aussavy F, Lepresle E, Pentier C, and Duvaldestin P
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- Adolescent, Adult, Aged, Aged, 80 and over, Ambulances, Anesthesia, General, Anesthesia, Local, Child, Child, Preschool, Critical Care statistics & numerical data, Female, France epidemiology, Heart Arrest mortality, Heart Arrest therapy, Hospital Mortality, Humans, Hypnotics and Sedatives therapeutic use, Infant, Infant, Newborn, Length of Stay, Male, Middle Aged, Neuromuscular Depolarizing Agents therapeutic use, Patient Care Team, Prognosis, Prospective Studies, Succinylcholine therapeutic use, Cardiopulmonary Resuscitation methods, Emergency Medical Services methods, Intubation, Intratracheal adverse effects
- Abstract
Objective: To investigate complications of emergency endotracheal intubation (EEI), possibly facilitated by rapid-sequence induction, in the prehospital critical care setting: 1) the difficulty of intubation; 2) the cardiorespiratory consequences of intubation; 3) the relationship between the occurrence of complications and prognosis., Study Design: Prospective non randomized, open study., Patients: All patients treated over a 5-month period by a physician-manned ambulance service and requiring EEI., Methods: Patients were allocated either in with cardiac arrest (CA) group or a group with maintained spontaneous circulation (SC). Difficulty of intubation was assessed by the number of attempts., Results: Two hundred and twenty-four consecutive EEI were carried out by physicians (46%) and residents (38%) not trained in anaesthesia, anaesthetists (8%), or nurse anaesthetists (7%). Trachea was intubated after a maximum of three attempts in all patients. Success rate at the first attempt was 91%. It was 92% in CA patients (n = 76) and 90% in SC patients (P = 0.59). Anaesthetic induction, with (n = 112) or without (n = 12) succinylcholine, was used to facilitate 84% of intubations in SC patients. Complications occurred in 30 patients (20%). There was no relationship between the latter and hospital mortality, duration of ventilatory support, duration of stay in the intensive care unit., Conclusion: In this study, EEI in SC patients was frequently facilitated by rapid sequence induction and was associated with a high success rate at the first attempt, as in CA patients. Morbidity was low. All physicians involved in emergency airway management should be skilled in this technique.
- Published
- 1997
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