Last posts on hémorragie2024-03-28T14:54:22+01:00All Rights Reserved blogSpirithttps://www.hautetfort.com/https://www.hautetfort.com/explore/posts/tag/hémorragie/atom.xmlMédecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlFluid Resuscitation in Tactical Combat Casualty Care. Update 201tag:citerahiadesgenettes.hautetfort.com,2022-01-20:63614772022-01-20T18:00:00+01:002022-01-20T18:00:00+01:00 Fluid Resuscitation in Tactical Combat Casualty Care TCCC Guidelines...
<p style="text-align: center;"><a href="https://www.jsomonline.org/Updates/20214126Deaton.pdf"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Fluid Resuscitation in Tactical Combat Casualty Care</span></strong></a><br /><a href="https://www.jsomonline.org/Updates/20214126Deaton.pdf"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">TCCC Guidelines Change 21-01</span></a><br /><a href="https://www.jsomonline.org/Updates/20214126Deaton.pdf"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">4 November 2021</span></a></p><p style="text-align: center;"> </p><p style="text-align: center;"> </p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Dans ce document le mot important est choc hémorragique. Ce n'est pas parce q'un blessé saigne qu'il est en état de choc. </span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlArrêter un saignement de languetag:citerahiadesgenettes.hautetfort.com,2020-07-18:62524612020-07-18T22:14:00+02:002020-07-18T22:14:00+02:00 Use of an improvised clamp to manage bleeding tongue injuries, Chen...
<p style="text-align: center;"><strong><span style="font-size: 14pt; font-family: arial, helvetica, sans-serif;">Use of an improvised clamp to manage bleeding tongue injuries,</span></strong></p><p style="text-align: center;"><a href="https://www.sciencedirect.com/science/article/abs/pii/S0735675720305404" target="_blank" rel="noopener">Chen M.W.J. et Al. Am J Emergency Medicine (2020), https://doi.org/10.1016/j.ajem.2020.06.051</a></p><p style="text-align: center;"> </p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Compresses éventuellement hémostatiques, deux abaisses langues, du sparadrap. Et voilà la langue est comprimée.</span></p><p style="text-align: center;"><img id="media-6154833" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/02/1131364722.jpg" alt="SAignement Langue.jpg" /></p><p style="text-align: center;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTXA et Plasma: A faire simultanément ?tag:citerahiadesgenettes.hautetfort.com,2018-07-08:60650482018-07-08T10:02:00+02:002018-07-08T10:02:00+02:00 Plasma coadministration improves resuscitation with tranexamic...
<div class="cit" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;"><span class="highlight">Plasma</span> <span class="highlight">coadministration</span> <span class="highlight">improves</span> <span class="highlight">resuscitation</span> with <span class="highlight">tranexamic</span> <span class="highlight">acid</span> or <span class="highlight">prothrombin</span> <span class="highlight">complex</span> in a <span class="highlight">porcine</span> <span class="highlight">hemorrhagic</span> <span class="highlight">shock</span> <span class="highlight">model</span></span>.</div><div class="auths" style="text-align: center;"> </div><div class="auths" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><a href="https://pdfs.journals.lww.com/jtrauma/2018/07000/Plasma_coadministration_improves_resuscitation.14.pdf?token=method|ExpireAbsolute;source|Journals;ttl|1531034750267;payload|mY8D3u1TCCsNvP5E421JYK6N6XICDamxByyYpaNzk7FKjTaa1Yz22MivkHZqjGP4kdS2v0J76WGAnHACH69s21Csk0OpQi3YbjEMdSoz2UhVybFqQxA7lKwSUlA502zQZr96TQRwhVlocEp/sJ586aVbcBFlltKNKo+tbuMfL73hiPqJliudqs17cHeLcLbV/CqjlP3IO0jGHlHQtJWcICDdAyGJMnpi6RlbEJaRheGeh5z5uvqz3FLHgPKVXJzdppqj1rZdz3BLjEDnu9HSi6HcZUFfnFaTZ78xQWYLEOI=;hash|GSXgWTElNa1jaf1+p7aFbA==" target="_blank" rel="noopener noreferrer"><span style="font-size: 10pt;">Kuckelman J et Al. J Trauma Acute Care Surg.</span><span style="font-size: 10pt;"> 2018 Jul;85(1):91-100</span></a><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Kuckelman%20J%5BAuthor%5D&cauthor=true&cauthor_uid=29958247"><br /></a></span></div><div class="auths" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><sup>--------------------------</sup></span></div><div class="auths" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><sup>Ce travail est effectué sur un modèle de choc hémorragique porcin (35% de la masse circulante 8 groupes randomisés selon l'administration de TXA, de PFC ou de PCC). Il est de manière très significative en faveur d'une co-administration du TXE et de plasma. Ces résultats sont obtenus avec l'administration d'une quantité relativement importante de plasma ce qui en clinique humaine peut représenter une difficulté logistique d'approvisionnement et de transport tactique. Le choix des auteurs d'induire une fibrinolyse pharmacologie par administration d'altéplase peut peut être expliquer la netteté des résultats rapportés?<br /></sup></span><div class=""><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">BACKGROUND:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Traumatic coagulopathy has now been well characterized and carries high rates of mortality owing to bleeding. A 'factor-based' <span class="highlight">resuscitation</span> strategy using procoagulant drugs and factor concentrates in lieu of <span class="highlight">plasma</span> is being used by some, but with little evidentiary support. We sought to evaluate and compare <span class="highlight">resuscitation</span> strategies using combinations of <span class="highlight">tranexamic</span> <span class="highlight">acid</span> (TXA), <span class="highlight">prothrombin</span> <span class="highlight">complex</span> concentrate (PCC), and fresh frozen <span class="highlight">plasma</span> (FFP).</span></p><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">METHODS:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Sixty adult swine underwent 35% blood volume hemorrhage combined with a truncal ischemia-reperfusion injury to produce uniform <span class="highlight">shock</span> and coagulopathy. Animals were randomized to control (n = 12), a single-agent group (TXA, n = 10; PCC, n = 8; or FFP, n = 6) or combination groups (TXA-FFP, n = 10; PCC-FFP, n = 8; TXA-PCC, n = 6). <span class="highlight">Resuscitation</span> was continued to 6 hours. Key outcomes included hemodynamics, laboratory values, and rotational thromboelastometry. Results were compared between all groups, with additional comparisons between FFP and non-FFP groups.</span></p><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">RESULTS:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">All 60 animals survived to 6 hours. <span class="highlight">Shock</span> was seen in all animals, with hypotension (mean arterial pressure, 44 mm Hg), tachycardia (heart rate, 145), acidosis (pH 7.18; lactate, 11), anemia (hematocrit, 17), and coagulopathy (fibrinogen, 107). <span style="background-color: #ffff99;"><strong>There were clear differences between groups for mean pH (p = 0.02), international normalized ratio (p < 0.01), clotting time (CT; p < 0.01), lactate (p = 0.01), creatinine (p < 0.01), and fibrinogen (p = 0.02)</strong></span>. <span style="background-color: #ffff99;"><strong>Fresh frozen <span class="highlight">plasma</span> groups had significantly improved <span class="highlight">resuscitation</span> and clotting parameters (Figures), with lower lactate at 6.5 versus 8.4 (p = 0.04), and increased fibrinogen at 126 versus 95 (p < 0.01).</strong> <strong>Rotational thromboelastometry also demonstrated shortened CT at 60 seconds in the FFP group vs 65 seconds in the non-FFP group (p = 0.04)</strong></span>.</span></p><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">CONCLUSION:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">When used to correct traumatic coagulopathy, combinations of FFP with TXA or PCC were superior in improving acidosis, coagulopathy, and CT than when these agents are given alone or in combination without <span class="highlight">plasma</span>. Further validation of pure factor-based strategies is needed.</span></p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTrauma jonctionnels: Une revuetag:citerahiadesgenettes.hautetfort.com,2018-03-01:60304582018-03-01T22:53:00+01:002018-03-01T22:53:00+01:00 Clic sur l'image pour accéder au document
<p style="text-align: center;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5022193/pdf/13049_2016_Article_301.pdf" target="_blank" rel="noopener noreferrer"><img id="media-5776210" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/00/3715505121.jpg" alt="Trau Jonc.jpg" width="384" height="156" /></a></p><p style="text-align: center;">Clic sur l'image pour accéder au document</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlAlbumine préhospitalière: Idée qui fait son chemintag:citerahiadesgenettes.hautetfort.com,2017-06-14:59540252017-06-14T09:09:00+02:002017-06-14T09:09:00+02:00 Albumin for Prehospital Fluid Resuscitation of Hemorrhagic Shock in...
<h1 class="cit" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Albumin for Prehospital Fluid Resuscitation of Hemorrhagic Shock in Tactical Combat Casualty Care</span></h1><div class="cit"> </div><div class="auths" style="text-align: center;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/28599038" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Studer NM et Al. J Spec Oper Med. 2017 Summer;17(2):82-88.</span></a></div><div class="abstr"><p style="text-align: center;">----------------------------------------</p><p style="text-align: justify;">Une publication récente de Kheirabadi BS et Al. (<a href="http://www.hautetfort.com/admin/posts/Kheirabadi BS et Al. J Trauma Acute Care Surg. 2016;81: 42–49" target="_blank">1</a>) évoque l'intérêt potentiel de l'albumine concentrée, notammment son pouvoir tampon important, pour la prise en charge de l'hémorragie, usage qu'il ne faut pas confondre avec celui de l'albumine à 4% dont l'emploi reste controversé (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065031/pdf/cc2943.pdf" target="_blank">2</a>) après l'étude SAFE (<a href="http://www.nejm.org/doi/pdf/10.1056/NEJMoa040232" target="_blank">3</a>). Lire ce point (<a href="https://ccforum.biomedcentral.com/track/pdf/10.1186/cc13991?site=ccforum.biomedcentral.com" target="_blank">5</a>)</p><p style="text-align: center;">----------------------------------------</p><div class=""><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Optimal fluid resuscitation on the battlefield in the absence of blood products remains unclear. Contemporary Combat medics are generally limited to hydroxyethyl starch or crystalloid solutions, both of which present significant drawbacks. Obtaining US Food and Drug Administration (FDA)-approved freeze-dried plasma (FDP) is a top casualty care research priority for the US Military. Interest in this agent reflects a desire to simultaneously expand intravascular volume and address coagulopathy. The history of FDP dates to the Second World War, when American expeditionary forces used this agent frequently. Also fielded was 25% albumin, an agent that lacks coagulation factors but offers impressive volume expansion with minimal weight to carry and requires no reconstitution in the field. The current potential value of 25% albumin is largely overlooked. Although FDP presents an attractive future option for battlefield prehospital fluid resuscitation once FDA approved, this article argues that in the interim, 25% albumin, augmented with fibrinogen concentrate and tranexamic acid to mitigate hemodilution effects on coagulation capacity, offers an effective volume resuscitation alternative that could save lives on the battlefield </span></p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlHémorragie: De la glace sur le visage ?tag:citerahiadesgenettes.hautetfort.com,2017-05-08:59416012017-05-08T14:20:00+02:002017-05-08T14:20:00+02:00 Face Cooling Increases Blood Pressure during Simulated Blood Loss B....
<h1 class="header_title" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Face Cooling Increases Blood Pressure during Simulated Blood Loss</span></h1><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">B. Johnson et Al. Proceedings of Experimental Biology 2017 Chicago</span> </p><p style="text-align: center;">-------------------------------------</p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Une constatation qui ne devrait pas surprendre ceux qui s'intéressent à la médecine de plongée et au réflexe d'immersion (<a href="http://aquatic-human-ancestor.org/files/diving-reflex-triggers-humans.pdf" target="_blank">1</a>,<a href="http://advan.physiology.org/content/27/3/130" target="_blank"> 2</a>, <a href="http://www.ijsrp.org/research-paper-0315/ijsrp-p3918.pdf" target="_blank">3</a>, <a href="https://www.researchgate.net/publication/8051692_The_human_diving_response_its_function_and_its_control" target="_blank">4</a>), dont le facteur principal de déclenchement est l'exposition de la face à de l'eau froide.</span></p><p style="text-align: center;">-------------------------------------</p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Introduction</strong> </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Blood loss causes central hypovolemia and in severe instances, it can decrease blood pressure and lead to cardiovascular decompensation. Simple and quick interventions that can be used to prevent cardiovascular decompensation in pre-hospital settings could be a valuable tool for first responsders. <span style="background-color: #ffff99;"><strong>Cooling the forehead and cheeks using an ice/water slurry mixture has been shown to increase blood pressure for over 15 minutes. Therefore, face cooling could be used to mitigate decreases in blood pressure during blood loss. </strong></span></span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Purpose</strong> </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">We tested the hypothesis that face cooling during simulated blood loss will increase blood pressure. Methods <span style="background-color: #ffff99;"><strong>Ten healthy participants</strong></span> (22 ± 2 years, 3 women) completed two randomized trials on separate days. Both trials began with <span style="background-color: #ffff99;"><strong>30 mmHg of lower body negative pressure (LBNP) to simulate blood loss for 6 minutes.</strong></span> Then, either a 2.5 L plastic bag of an ice/water slurry mixture (0 ± 0°C) (LBNP+FC) or a 2.5 L plastic bag of thermoneutral water (34 ± 1°C) (LBNP+SHAM) was placed on the forehead and eyes and 30 mmHg of LBNP was maintained for an additional 15 minutes. </span></p><p style="text-align: center;"><img style="margin: 0.7em 0;" src="https://3c1703fe8d.site.internapcdn.net/newman/csz/news/800/2017/1-possiblenewt.jpg" alt="1-possiblenewt.jpg" width="237" height="177" /></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">We continuously measured blood pressure (Penaz method), heart rate (ECG), stroke volume (Modelflow), cardiac output, total peripheral resistance, and forehead temperature throughout the protocol. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Results</strong> </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Forehead temperature did not change from LBNP (34.2 ± 0.6°C) to LBNP+SHAM (33.9 ± 1.4°C, P > 0.999) and decreased from LBNP (34.4 ± 0.5°C) to LBNP+FC (11.0 ± 1.6°C, P < 0.001). <span style="background-color: #ffff99;"><strong>Mean arterial pressure did not change from LBNP (82 ± 10 mmHg) to LBNP+SHAM (80 ± 8 mmHg, P = 0.978), but markedly increased during LBNP+FC</strong></span>. The <span style="background-color: #ffff99;"><strong>peak increase from LBNP (77 ± 9 mmHg) was observed after 3 minutes of LBNP+FC</strong></span> (98 ± 15 mmHg, P < 0.001). Heart rate during LBNP (76 ± 14 bpm, P = 0.978) was not different from LBNP+SHAM (75 ± 13 bpm). Heart rate was lower throughout LBNP+FC beginning at 2 minutes of FC (60 ± 16 bpm) versus LBNP (80 ± 19 bpm, P < 0.001). Stroke volume did not change from LBNP (72 ± 15 mL) to LBNP+SHAM (67 ± 18 mL, P = 0.857). <span style="background-color: #ffff99;"><strong>However, stroke volume increased from LBNP (78 ± 16 mL) to LBNP+FC, and peaked after 5 minutes of FC</strong> </span>(97 ± 32 mL, P < 0.001). Cardiac output did not change from LBNP (5.4 ± 1.0 L/min) to LBNP+SHAM (4.9 ± 1.0 L/min, P > 0.415). Cardiac output slightly decreased from LBNP (6.2 ± 1.5 L/min) to 2 minutes of LBNP+FC (5.3 ± 1.6 L/min, P = 0.038). Total peripheral resistance did not change from LBNP (15.6 ± 3.7 mmHg/L/min) to LBNP+SHAM (17.3 ± 3.2 mmHg/L/min, P = 0.613). <span style="background-color: #ffff99;"><strong>Total peripheral resistance throughout LBNP+FC was greater than LBNP. The peak increase in total peripheral resistance was observed after 2 minutes of LBNP+FC (20.0 ± 6.2 mmHg/L/min) versus LBNP (13.2 ± 3.9 mmHg/L/min, P < 0.001). </strong></span></span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Conclusions</strong> </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><span style="background-color: #ffff99;"><strong>Face cooling during simulated moderate blood loss increases blood pressure through an increase in total peripheral resistance</strong></span>. Although more research is warranted, face cooling during blood loss is a potential simple and quick intervention that could delay cardiovascular decompensation. Support or Funding InformationUniversity at Buffalo IMPACT Award</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlREBOA: Une technique qui trouve sa placetag:citerahiadesgenettes.hautetfort.com,2017-03-23:59245982017-03-23T06:31:50+01:002017-03-23T06:31:50+01:00 Resuscitative endovascular balloon occlusion of the aorta for uncontrolled...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;"><strong>Resuscitative endovascular balloon occlusion of the aorta for uncontrolled haemorrhagic shock as an adjunct to haemostatic procedures in the acute care setting</strong></span></h1><p style="text-align: center;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748599/pdf/13049_2016_Article_205.pdf" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;"><span style="font-size: 12pt;">Tsurukiri J et Al. Tsurukiri et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2016) 24:13</span><strong> </strong></span></a></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">-------------------------------</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Le principe d'occlusion artérielle n'est pas nouveau. L'occlusion endovasculaire de l'aorte trouve sa place dans la gestion des hémorragies abdominales incontrôlable. Son intérêt en traumatologie ballistique de guerre est probable (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748599/pdf/13049_2016_Article_205.pdf" target="_blank">1</a>). Cette technique a été récemment décrite en phase préhospitalière (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123207/pdf/1757-7241-22-S1-P19.pdf" target="_blank">2</a>). Nos conditions d'exercice méritent que l'on s'intéresse à cette technique (<a href="http://www.usaisr.amedd.army.mil/cpgs/REBOA_for_Hemorrhagic_Shock_16Jun2014.pdf12000-00062.pdf">3</a>).</span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">-------------------------------</span></p><p> </p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Background:</strong> </span></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Haemorrhagic shock is a major cause of death in the acute care setting. Since 2009, our emergency department has used intra-aortic balloon occlusion (IABO) catheters for resuscitative endovascular balloon occlusion of the aorta (REBOA). </span></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Methods:</strong> REBOA procedures were performed by one or two trained acute care physicians in the emergency room (ER) and intensive care unit (ICU). IABO catheters were positioned using ultrasonography. Collected data included clinical characteristics, haemorrhagic severity, blood cultures, metabolic values, blood transfusions, REBOA-related complications and mortality. </span></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Results:</strong> Subjects comprised 25 patients (trauma, n = 16; non-trauma, n = 9) with a median age of 69 years and a median shock index of 1.4. REBOA was achieved in 22 patients, but failed in three elderly trauma patients. Systolic blood pressure significantly increased after REBOA (107 vs. 71 mmHg, p < 0.01). Five trauma patients (20 %) died in ER, and mortality rates within 24 h and 60 days were 20 % and 12 %, respectively. No REBOA-related complications were encountered. The total occlusion time of REBOA was significantly lesser in survivors than that in non-survivors (52 vs. 97 min, p < 0.01). Significantly positive correlations were found between total occlusion time of REBOA and shock index (Spearman’s r = 0.6) and lactate concentration (Spearman’s r = 0.7) in survivors. </span></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Conclusion:</strong> REBOA can be performed in ER and ICU with a high degree of technical success. Furthermore, correlations between occlusion time and initial high lactate levels and shock index may be important because prolonged occlusion is associated with a poorer outcome.</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlQuikClot: Du nouveau, pour l'hôpitaltag:citerahiadesgenettes.hautetfort.com,2017-02-04:59070602017-02-04T14:04:00+01:002017-02-04T14:04:00+01:00 La gamme quikclot s'agrandit avec toute une proposition de pansement adapté...
<p>La gamme quikclot s'agrandit avec toute une proposition de pansement adapté à l'usage hospitalier, que ce soit peropératoire ou en soins critiques.</p><p> </p><p><img style="margin: 0.2em auto 1.4em; display: block;" src="http://www.surv24.ru/blogs/wp-content/uploads/2013/11/Quikclot_Radial_Hemostatic_Bandage_interventional_bandage.jpg" alt="Quikclot_Radial_Hemostatic_Bandage_interventional_bandage.jpg" width="367" height="251" /></p><p style="text-align: center;"><img style="margin: 0.7em 0;" src="http://quikclot.com/QuikClot/media/Product-Images/image-prod-188-20151019.png?width=591&height=800&ext=.png" alt="image-prod-188-20151019.png?width=591&height=800&ext=.png" width="368" height="499" /></p><p style="text-align: center;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlCoagulopathie: Une affaire personnelletag:citerahiadesgenettes.hautetfort.com,2017-02-02:59061322017-02-02T07:49:08+01:002017-02-02T07:49:08+01:00 Individual clotting factor contributions to mortality following trauma....
<h1 class="cit" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Individual clotting factor contributions to mortality following trauma.</span></h1><div class="auths" style="text-align: center;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/27906868" target="_blank">Kunitake RC<span style="font-size: 10px;"> et Al. J Trauma Acute Care Surg. 2017 Feb;82(2):302-308. doi: 10.1097/TA.0000000000001313.</span></a></div><div class="afflist"> </div><div class="abstr"><div class=""><h4 style="text-align: center;">-------------------------------</h4><p>Un travail intéressant qui portant sur 1463 traumatisés d'ISS médian de 16 et qui met en avant l'existence de deux profils de coagulopathie traumatique (16% des patients pris en charge). Dans 49,30 des cas, un premier est en rapport avec des anomalies des facteurs II,VII,IX,X et protéine C . Le second profil (17% des patients) exprime des anomalies sur les facteurs V et VIII. Seuls seraient liés à une motralité à 28j. LA déplétion en facteur V serait associée à une mortalité à long terme. Ce travail milite pour une approche personnalisée de la ocaguklopathie traumatique.</p><h4 style="text-align: center;">-------------------------------</h4><h4>BACKGROUND:</h4><p>Acute traumatic coagulopathy affects 20% to 30% of trauma patients, but the extensive collinearity of the coagulation cascade complicates attempts to clarify global clotting factor dysfunction. This study aimed to characterize phenotypes of clotting factor dysfunction and their contributions to mortality after major trauma.</p><h4>METHODS:</h4><p>This prospective cohort study examines all adult trauma patients of the highest activation level presenting to San Francisco General Hospital between February 2005 and February 2015. Factors II, V, VII, VIII, IX, and X and protein C activity on admission and mortality status at 28 days were assessed. Predictors of 28-day mortality in univariate analysis were included in multiple logistic regression controlling for traumatic brain injury (TBI), acidosis, age, and mechanism of injury. Principal component analysis was utilized to identify phenotypic coagulation.</p><h4>RESULTS:</h4><p>Complete coagulation factor data were available for 876 (61%) of 1,429 patients. In multiple logistic regression, factors V (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.76-0.97), VIII (OR, 0.97; 95% CI, 0.95-0.99), and X (OR, 0.79; 95% CI, 0.68-0.92) and protein C (OR, 1.17; 95% CI, 1.05-1.30) significantly predicted 28-day mortality after controlling for age, base deficit, mechanism of injury, and TBI. Principal component analysis identified two significant principal components (Phenotypes 1 and 2) that accounted for 66.3% of the total variance. Phenotype 1 (factors II, VII, IX, and X and protein C abnormalities) explained 49.3% and was associated with increased injury, coagulopathy, TBI, and mortality. Phenotype 2 (factors V and VIII abnormalities) explained 17.0% and was associated with increased coagulopathy, blunt injury, and mortality. Only Phenotype 2 remained significantly associated with 28-day mortality in multiple logistic regression.</p><h4>CONCLUSIONS:</h4><p>Principal component analysis identified two distinct phenotypes within the entirety of global clotting factor abnormalities, and these findings substantiate the crucial association of factors V and VIII on mortality following trauma. This may be the first step toward identifying unique phenotypes after injury and personalizing hemostatic resuscitation.</p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.html1/1/1 ou 1/1/2 ?tag:citerahiadesgenettes.hautetfort.com,2016-01-09:57420812016-01-09T08:45:18+01:002016-01-09T08:45:18+01:00 Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the <span class="highlight">PROPPR</span> randomized <span class="highlight">clinical</span> <span class="highlight">trial</span></span></h1><p style="text-align: center;"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374744/pdf/nihms669314.pdf" target="_blank">Holcomb JB et All. JAMA Surg. 2013 Feb;148(2):127-36</a></p><p style="text-align: center;">______________________________</p><p style="text-align: justify;">La reconnaissance et la mise en place de la meilleure stratégie thérapeutique du choc hémorragique traumatique sont des enjeux fondamentaux qui se posent aux équipes de réanimation préhospitalières et hospitalières. L'application du concepts du damage control resuscitation <a href="http://www.bloodreviews.com/article/S0268-960X(15)00003-X/pdf" target="_blank">(1)</a> vise par la mise en place d'un stratégie raisonnée d'arrêt des hémorragies (<a href="http://citerahiadesgenettes.hautetfort.com/media/00/02/1595603420.pdf" target="_blank">2</a>), d'un remplissage vasculaire mesuré <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825889/pdf/11999_2013_Article_3122.pdf" target="_blank">(3)</a> et d'une politique transfusionnelle spécifique (<a href="http://bja.oxfordjournals.org/content/109/suppl_1/i39.full.pdf+html" target="_blank">4</a>). Parmi ces mesures, il apparaît important de garantir l'apport équilibré de plasma, de plaquettes et de CGR dans un ration élevé 1/1/1 ou 1/1/2. Deux études se sont attachées à ce point: L'étude <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740072/pdf/nihms462781.pdf" target="_blank">PROMMTT</a> et l'étude PROPPR ici présentée. La première confirme le bénéfice d'une telle stratégie avec une moindre mortalité chez les patients bénéficiant de rapport élevé supérieur mais uniquement dans les 6 premières heures. L'étude PROPPR semble confirmer ces données avec une moindre mortalité précoce par hémorragie mais ne réussit pas à confirmer l'intérêt d'un ratio 1/1/1 par rapport à un ratio 1/1/2 sur la mortalité à long terme.</p><p style="text-align: center;">______________________________</p><h4>IMPORTANCE:</h4><p>Severely injured patients experiencing hemorrhagic shock often require massive transfusion. Earlier transfusion with higher blood product ratios (plasma, platelets, and red blood cells), defined as damage control resuscitation, has been associated with improved outcomes; however, there have been no large multicenter <span class="highlight">clinical</span> <span class="highlight">trials</span>.</p><h4>OBJECTIVE:</h4><p>To determine the effectiveness and safety of transfusing patients with severe trauma and major bleeding using plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio.</p><h4>DESIGN, SETTING, AND PARTICIPANTS:</h4><p>Pragmatic, phase 3, multisite, randomized <span class="highlight">clinical</span> <span class="highlight">trial</span> of 680 severely injured patients who arrived at 1 of 12 level I trauma centers in North America directly from the scene and were predicted to require massive transfusion between August 2012 and December 2013.</p><h4>INTERVENTIONS:</h4><p>Blood product ratios of 1:1:1 (338 patients) vs 1:1:2 (342 patients) during active resuscitation in addition to all local standard-of-care interventions (uncontrolled).</p><h4>MAIN OUTCOMES AND MEASURES:</h4><p>Primary outcomes were 24-hour and 30-day all-cause mortality. Prespecified ancillary outcomes included time to hemostasis, blood product volumes transfused, complications, incidence of surgical procedures, and functional status.</p><h4>RESULTS:</h4><p>No significant differences were detected in mortality at 24 hours (12.7% in 1:1:1 group vs 17.0% in 1:1:2 group; difference, -4.2% [95% CI, -9.6% to 1.1%]; P = .12) or at 30 days (22.4% vs 26.1%, respectively; difference, -3.7% [95% CI, -10.2% to 2.7%]; P = .26). Exsanguination, which was the predominant cause of death within the first 24 hours, was significantly decreased in the 1:1:1 group (9.2% vs 14.6% in 1:1:2 group; difference, -5.4% [95% CI, -10.4% to -0.5%]; P = .03). More patients in the 1:1:1 group achieved hemostasis than in the 1:1:2 group (86% vs 78%, respectively; P = .006). Despite the 1:1:1 group receiving more plasma (median of 7 U vs 5 U, P < .001) and platelets (12 U vs 6 U, P < .001) and similar amounts of red blood cells (9 U) over the first 24 hours, no differences between the 2 groups were found for the 23 prespecified complications, including acute respiratory distress syndrome, multiple organ failure, venous thromboembolism, sepsis, and transfusion-related complications.</p><h4>CONCLUSIONS AND RELEVANCE:</h4><p>Among patients with severe trauma and major bleeding, early administration of plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio did not result in significant differences in mortality at 24 hours or at 30 days. However, more patients in the 1:1:1 group achieved hemostasis and fewer experienced death due to exsanguination by 24 hours. Even though there was an increased use of plasma and platelets transfused in the 1:1:1 group, no other safety differences were identified between the 2 groups.</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTransfusion de CGR: Les + graves seulementtag:citerahiadesgenettes.hautetfort.com,2015-12-25:57356402015-12-25T09:10:00+01:002015-12-25T09:10:00+01:00 Red Blood Cell Transfusion and Mortality in Trauma Patients:...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Red Blood Cell Transfusion and Mortality in Trauma Patients: Risk-Stratified Analysis of an Observational Study</span></h1><p style="text-align: center;"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060995/pdf/pmed.1001664.pdf" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Perel P et Al. PLoS Med. 2014 Jun 17;11(6):e1001664</span></a></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">-------------------------------------</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Les données qui suivent sont extraites de la cohorte des patients inclus dans l'étude CRASH2. Cette réinterprétation des données a pour objectif d'analyser le lien entre la mortalité à 28 jours et la transfusion de CGR. Les auteurs retrouvent un effet délétère de la transfusion de CGR pour les patients les moins à risque de mortalité. Ceci est en faveur des démarches de stratégies transfusionnelles sinon restrictives du moins raisonnées en fonction du contexte notamment préhospitalier où cette pratique associée à l'apport de fractions coagulantes semble être d'un grand intérêt(<a href="http://www.ncbi.nlm.nih.gov/pubmed/24932734" target="_blank">1</a>).</span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">-------------------------------------</span></p><p style="text-align: justify;"><strong>Background:</strong></p><p style="text-align: justify;"><span style="color: #000000; background-color: #ffff99;"><strong>Haemorrhage is a common cause of death in trauma patients</strong>.</span> Although transfusions are extensively used in the care of bleeding trauma patients, <span style="background-color: #ffff99;"><strong>there is uncertainty about the balance of risks and benefits</strong></span> and how this balance depends on the baseline risk of death. Our objective was to evaluate the association of red blood cell (RBC) transfusion with mortality according to the predicted risk of death.</p><p style="text-align: justify;"><strong>Methods and Findings:</strong></p><p style="text-align: justify;">A secondary analysis of the CRASH-2 trial (which originally evaluated the effect of tranexamic acid on mortality in trauma patients) was conducted. The trial included 20,127 trauma patients with significant bleeding from 274 hospitals in 40 countries. We evaluated the association of RBC transfusion with mortality in four strata of predicted risk of death: ,6%, 6%–20%, 21%–50%, and .50%. For this analysis the exposure considered was RBC transfusion, and the main outcome was death from all causes at 28 days. A total of 10,227 patients (50.8%) received at least one transfusion. <span style="background-color: #ffff99;"><strong>We found strong evidence that the association of transfusion with all-cause mortality varied according to the predicted risk of death</strong></span> (p-value for interaction ,0.0001). Transfusion was associated with an increase in all-cause mortality among patients with , 6% and 6%–20% predicted risk of death (odds ratio [OR] 5.40, 95% CI 4.08–7.13, p,0.0001, and OR 2.31, 95% CI 1.96–2.73, p,0.0001, respectively), but with a decrease in all-cause mortality in patients with .50% predicted risk of death (OR 0.59, 95% CI 0.47–0.74, p,0.0001).<span style="background-color: #ffff99;"><strong> Transfusion was associated with an increase in fatal and non-fatal vascular events (OR 2.58, 95% CI 2.05–3.24, p,0.0001). The risk associated with RBC transfusion was significantly increased for all the predicted risk of death categories, but the relative increase was higher for those with the lowest (,6%) predicted risk of death</strong></span> (p-value for interaction ,0.0001). As this was an observational study, the results could have been affected by different types of confounding. In addition, we could not consider haemoglobin in our analysis. In sensitivity analyses, excluding patients who died early; conducting propensity score analysis adjusting by use of platelets, fresh frozen plasma, and cryoprecipitate; and adjusting for country produced results that were similar.</p><p style="text-align: center;"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060995/pdf/pmed.1001664.pdf" target="_blank"><img style="margin: 0.7em 0;" src="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060995/bin/pmed.1001664.g001.jpg" alt="pmed.1001664.g001.jpg" width="305" height="195" /></a></p><p style="text-align: justify;"><strong><br />Conclusions:</strong></p><p style="text-align: justify;">The association of transfusion with all-cause mortality appears to vary according to the predicted risk of death. <span style="background-color: #ffff99;"><strong>Transfusion may reduce mortality in patients at high risk of death but increase mortality in those at low risk.</strong></span> The effect of transfusion in low-risk patients should be further tested in a randomised trial.</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlAmputé des jambes: Le bassin aussi !tag:citerahiadesgenettes.hautetfort.com,2015-12-19:57331352015-12-19T08:32:00+01:002015-12-19T08:32:00+01:00 The incidence of pelvic fractures with traumatic lower limb amputation in...
<h1 id="yui_3_14_1_1_1450508902864_1330" class="pub-title" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">The incidence of pelvic fractures with traumatic lower limb amputation in modern warfare due to improvised explosive devices</span></h1><p style="text-align: center;"><span style="font-size: 10pt;"><a href="file:///C:/Users/Baptiste/Desktop/Cross%202014%20Blast%20pelvic%20fracture.pdf" target="_blank"><span style="font-family: arial, helvetica, sans-serif; color: #000000;">Cross AM et Al. J R Nav Med Serv 2014;100(2):152-6</span></a></span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: #000000;">---------------------------------------------</span></p><p><span style="font-size: 10pt; color: #000000;">Excepté l'extraction d'urgence de blessés sous le feu, la prise en charge den cas d'amputation traumatique doit inclure la forte probabilité de traumatisme du bassin. Une utilisation large des <a href="http://citerahiadesgenettes.hautetfort.com/list/procedure/stabilisation-pelvienne.html" target="_blank">immobilisations pelviennes</a> doit donc être à l'esprit. On rappelle simplement la gravité et la difficulté de prise en charge des hémorragies liées aux fractures de bassin.</span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: #000000;">---------------------------------------------</span></p><p style="text-align: left;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>AIMS</strong>:</span></p><p style="text-align: left;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">A frequently-seen injury pattern in current military experience is traumatic lower limb <span class="highlight">amputation</span> as a result of improvised explosive devices (IEDs). This injury can coexist with fractures involving the pelvic ring. This study aims to assess the frequency of concomitant pelvic fracture in IED-related lower limb <span class="highlight">amputation</span>.</span></p><h4><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">METHODS:</span></h4><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">A retrospective analysis of the trauma charts, medical notes, and digital imaging was undertaken for all patients arriving at the Emergency Department at the UK military field hospital in Camp Bastion, Afghanistan, with a traumatic lower limb <span class="highlight">amputation</span> in the six months between September 2009 and April 2010, in order to determine the incidence of associated pelvic ring fractures.</span></p><h4><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">RESULTS:</span></h4><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Of 77 consecutive patients with traumatic lower limb amputations, 17 (<span style="background-color: #ffff99;"><strong>22%) had an associated pelvic fracture</strong></span> (eleven with displaced pelvic ring fractures, five undisplaced fractures and one acetabular fracture). <span style="background-color: #ffff99;"><strong>Unilateral amputees (n = 31) had a 10% incidence of associated pelvic fracture, whilst 30 % of <span class="highlight">bilateral</span> amputees (n = 46) had a concurrent pelvic fracture. However, in <span class="highlight">bilateral</span>, trans-femoral amputations (n = 28) the incidence of pelvic fracture was 39%.</strong></span></span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><a href="http://citerahiadesgenettes.hautetfort.com/media/00/01/4006871055.jpg" target="_blank"><img id="media-5244610" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/00/01/2048777887.jpg" alt="PelvicFractures.jpg" width="284" height="369" /></a></span></p><div style="text-align: center;" data-canvas-width="371.9391861926233"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">BKA - Below knee amputation; AKA - Above knee amputation</span></div><h4><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">CONCLUSIONS:</span></h4><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">The study demonstrates a high incidence of pelvic fractures in patients with traumatic lower limb amputations, supporting the routine pre-hospital application of pelvic binders in this patient group</span></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/00/01/1943092733.jpg" target="_blank"><img id="media-5244607" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/00/01/2703097470.jpg" alt="PelvicImmobilisation.jpg" /></a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlStratégie Low Flow: Encore confirméetag:citerahiadesgenettes.hautetfort.com,2015-11-19:57185752015-11-19T07:22:00+01:002015-11-19T07:22:00+01:00 Efficacy of limited fluid resuscitation in patients with hemorrhagic shock:...
<h1 class="content-title" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Efficacy of limited fluid resuscitation in patients with hemorrhagic shock: a meta-analysis</span></h1><p style="text-align: center;"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565384/pdf/ijcem0008-11645.pdf" target="_blank">Duan C. et Al. Int J Clin Exp Med. 2015; 8(7): 11645–11656.</a></p><p style="text-align: center;"><img style="margin: 0.7em 0;" src="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565384/bin/ijcem0008-11645-f2.jpg" alt="ijcem0008-11645-f2.jpg" width="464" height="299" /></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlQuelle place pour les facteurs de la coagulation ?tag:citerahiadesgenettes.hautetfort.com,2015-10-23:57048532015-10-23T16:35:00+02:002015-10-23T16:35:00+02:00 Clic sur l'image pour suivre la conférence
<p style="text-align: center;"><a href="http://srlf.cyim.com/rc/2012/srlf2012/medecin-20/session/20120118-1645-1604/1745-6088/pcast/src/hd/pcast.mp4" target="_blank"><img id="media-5193266" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/02/397929947.jpg" alt="PlaceFactCoag.jpg" width="363" height="247" /></a></p><p style="text-align: center;">Clic sur l'image pour suivre la conférence</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlRFE Choc hémorragiquetag:citerahiadesgenettes.hautetfort.com,2015-02-07:55543272015-02-07T22:42:00+01:002015-02-07T22:42:00+01:00 Clic sur l'image pour accéder au document
<p><a href="https://sfar.org/recommandations-sur-la-reanimation-du-choc-hemorragique/" target="_blank" rel="noopener noreferrer"><img id="media-4896213" style="margin: 0.7em auto; display: block;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/01/3789865290.jpg" alt="rfe ChocHem.jpg" width="383" height="128" /></a></p><p style="text-align: center;"> Clic sur l'image pour accéder au document</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPlaquettes synthétiques: Possible ? Mais ouitag:citerahiadesgenettes.hautetfort.com,2014-10-30:54795282014-10-30T21:35:00+01:002014-10-30T21:35:00+01:00 Tuning Ligand Density on Intravenous Hemostatic Nanoparticles Dramatically...
<h1 class="content-title" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">Tuning Ligand Density on Intravenous Hemostatic Nanoparticles Dramatically Increases Survival Following Blunt Trauma</span></h1><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><a href="http://www.pnas.org/content/111/28/10293" target="_blank">Proc Natl Acad Sci U S A. 2014 Jul 15;111 (28) 10293-10298</a></span></p><p style="text-align: justify;"><span style="color: #333333; font-family: Arial, sans-serif; font-size: 14px; line-height: 21px; text-align: justify;">Des plaquettes synthétiques pour arrêter le saignement ? Certains l'ont fait grâce à la technologie des nanoparticules <span style="color: #000000;">(<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992987/pdf/nihms-249585.pdf" target="_blank"><span style="color: #000000;">1</span></a>, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3758899/pdf/nihms506617.pdf" target="_blank"><span style="color: #000000;">2</span></a>).</span> Un espoir qui reste à confirmer.</span></p><p style="text-align: center;"><span style="color: #333333; font-family: Arial, sans-serif; font-size: 14px; line-height: 21px; text-align: justify;">-----------------------------------------------------------------------------------</span></p><p style="text-align: justify;"><span style="color: #333333; font-family: Arial, sans-serif; font-size: 14px; line-height: 21px; text-align: justify;">Explosions account for 79% of combat-related injuries, leading to multiorgan hemorrhage and uncontrolled bleeding. Uncontrolled bleeding is the leading cause of death in battlefield traumas as well as in civilian life. We need to stop the bleeding quickly to save lives, but, shockingly, there are no treatments to stop internal bleeding. A therapy that halts bleeding in a site-specific manner and is safe, stable at room temperature, and easily administered is critical for the advancement of trauma care. To address this need, we have developed hemostatic nanoparticles that are administered intravenously. When tested in a model of blast trauma with multiorgan hemorrhaging, <strong><span style="background-color: #ffff99;">i.v. administration of the hemostatic nanoparticles led to a significant improvement in survival over the short term (1 h postblast).</span></strong> No complications from this treatment were apparent out to 3 wk. This work demonstrates that these particles have the potential to save lives and fundamentally change trauma care.</span></p><p style="text-align: center;"><span style="color: #333333; font-family: Arial, sans-serif; font-size: 13.63636302948px; line-height: 21px;">-----------------------------------------------------------------------------------</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPansements hémostatiques: Actualisation 2014tag:citerahiadesgenettes.hautetfort.com,2014-10-23:54743352014-10-23T08:06:00+02:002014-10-23T08:06:00+02:00 Review of New Topical Hemostatic Dressings for Combat Casualty Care...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">Review of New Topical Hemostatic Dressings for Combat Casualty Care</span></h1><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><a href="http://technews.tmcnet.com/news/2014/05/14/7828703.htm" target="_blank">Benett BL et Al Mil Med. 2014 May;179(5):497-514</a></span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">This review analyzes the new (2008-2013) hemostatic agents and dressings for enhanced efficacy in preclinical studies, and investigates supportive findings among case reports of effectiveness and safety in hospital and prehospital literature. A literature search was conducted using PubMed, National Library of Medicine using key words and phrases. The search revealed a total of 16 articles that fit the criteria established for third-generation hemostatic dressings. There were a total of 9 preclinical, 5 clinical, and 2 prehospital studies evaluated. Evaluation of these third- generation studies reveals that mucoadhesive (chitosan) dressings, particularly Celox Gauze and ChitoGauze, clearly show equal efficacy to Combat Gauze across many dependent variables. Chitosan-based products are ideal prehospital dressings because they are shown to work independently from the physiological clotting mechanisms. Many first-, second-, and third-generation chitosan-based dressings have been in use for years by the United States and other NATO militaries at the point of injury, and during tactical evacuation, in Operation Enduring Freedom and Operation Iraqi Freedom without reported complications or side effects. Based on the reported efficacy and long-term safety of chitosan-based products, increased use of Celox Gauze and ChitoGauze within the Department of Defense and civilian venues merits further consideration and open debate.</span></p>
MILIQUEhttp://aumagmapresentdelecriture.hautetfort.com/about.htmlLENTE HÉMORRAGIEtag:aumagmapresentdelecriture.hautetfort.com,2014-08-01:53785012014-08-01T09:20:00+02:002014-08-01T09:20:00+02:00 LENTE HÉMORRAGIE Il est à espérer ton quotidien...
<p style="text-align: center;"><img id="media-4573078" style="margin: 0.7em 0;" title="" src="http://aumagmapresentdelecriture.hautetfort.com/media/01/02/1240668360.jpg" alt="au magma présent de l'écriture," /></p><p style="text-align: center;"> </p><p style="margin-bottom: 0cm; page-break-before: always; text-align: center;"><span style="font-family: arial black,avant garde; font-size: large;"><strong><span style="font-size: x-large; color: #008000;">LENTE HÉMORRAGIE</span><br clear="none" /></strong></span></p><p style="margin-bottom: 0cm; text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: large;"><strong>Il est à espérer ton quotidien se révèle plus lumineux que le mien,</strong></span></p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: large;"><strong>Car tu n’as pas l’âge de payer cash les tâtonnements de l’existence.</strong></span></p><p style="margin-bottom: 0cm; text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: large;"><strong>Je me suis interrogé jusqu’à l’obsession, et malgré le désir de faire beau,</strong></span></p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: large;"><strong>Je ne peux que confirmer qu’elle n’est que doutes et colères rémanents.</strong></span></p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: large;"><strong>C’est une part d’irrationnel qui envahit la réalité de ses éclats d’arbitraire,</strong></span></p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: large;"><strong>C’est une fresque naturaliste mais effrayante en ses interrogations inouïes</strong></span></p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: large;"><strong>Lorsqu’en ses corridors coule la lente hémorragie d’inguérissables blessures,</strong></span></p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: large;"><strong>Véritable concentré de cauchemars obscurs, vie réelle aux perfides morsures.</strong></span></p><p style="margin-bottom: 0cm; text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: large;"><strong>La tempête déchire l’air, et le tableau est accablant qui rend le jour chagrin.</strong></span></p><p style="margin-bottom: 0cm; text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-size: large;"><strong><span style="font-family: arial black,avant garde;">P. MILIQUE</span> </strong></span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPansements hémostatiques: Utilité non démontréetag:citerahiadesgenettes.hautetfort.com,2014-05-31:53817962014-05-31T22:35:00+02:002014-05-31T22:35:00+02:00 Haemostatic dressings in prehospital care Hewitt Smith A. et...
<p style="text-align: center;"><strong><span style="font-family: arial,helvetica,sans-serif; font-size: medium;">Haemostatic dressings in prehospital care</span></strong></p><p style="text-align: center;"><a href="http://conovers.org/ftp/Haemostatic-dressings-in-prehospital-care.pdf" target="_blank"><em><span style="font-size: small;"><span style="font-family: arial,helvetica,sans-serif;">Hewitt Smith A. et Al. </span></span>Emerg Med J 2013; 30:784–789</em></a></p><p style="text-align: center;"><em>--------------------------------------------------------------</em></p><p style="text-align: justify;"><span style="font-family: arial,helvetica,sans-serif; font-size: small;">Une revue de littérature qui confirme que le bien fondé de l'emploi des pansements hémostatiques n'est pas si solide que cela. Pansement compressif et packing de plaie sont des valeurs sûres.</span></p><p style="text-align: center;"><em>--------------------------------------------------------------</em></p><div style="text-align: justify;" dir="ltr" data-angle="0" data-font-name="g_font_89_0" data-canvas-width="279.99824437837594"><span style="font-family: arial,helvetica,sans-serif; font-size: small;">Massive haemorrhage still accounts for up to 40% of mortality after traumatic injury. The importance of limiting blood loss after injury in order to prevent its associated complications has led to rapid advances in the development of dressings for haemostatic control. Driven by recent military conflicts, there is increasing evidence to support their role in the civilian prehospital care environment. This review aims to summarise the key characteristics of the haemostatic dressings currently available on the market and provide an educational review of the published literature that supports their use. Medline and Embase were searched from start to January 2012. Other sources included both manufacturer and military publications. Agents not designed for use in prehospital care or that have been removed from the market due to significant safety concerns were excluded. The dressings reviewed have differing mechanisms of action. Mineral based dressings are potent activators of the intrinsic clotting cascade resulting in clot formation. Chitosan based dressings achieve haemostasis by adhering to damaged tissues and creating a physical barrier to further bleeding. Acetylated glucosamine dressings work via a combination of platelet and clotting cascade activation, agglutination of red blood cells and local vasoconstriction. <em><span style="background-color: #ffff99;"><strong>Anecdotal reports strongly support the use of haemostatic dressings when bleeding cannot,be controlled using pressure dressings alone; however, current research focuses on studies conducted using animal models. There is a paucity of published clinical literature that provides an evidence base for the use of one type of haemostatic dressing over another in humans</strong></span></em></span></div><p style="text-align: justify;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlLe point sur le contrôle des hémorragies externestag:citerahiadesgenettes.hautetfort.com,2014-04-07:53414292014-04-07T07:41:00+02:002014-04-07T07:41:00+02:00 An Evidence-based Prehospital Guideline for External Hemorrhage Control:...
<h1 style="font-size: 1.231em; margin: 0.375em 0px; line-height: 1.125em; font-family: arial, helvetica, clean, sans-serif; text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">An Evidence-based Prehospital Guideline for External Hemorrhage Control: American College of Surgeons Committee on <span class="highlight">Trauma</span></span></h1><p style="text-align: center;"><a href="http://www.naemt.org/Files/PHTLS/Bulger.evidence%20based%20prehospital%20guideline%20for%20external%20hemorrhage%20control.%20ACS%20COT.%20PEC%202014.pdf" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><span class="highlight">Bulger EM et Al. </span></span><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.956525802612305px;"><span style="color: #660066;">Prehosp Emerg Care.</span></span><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.956525802612305px;"> 2014 Apr-Jun;18(2):163-73.</span></a></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><span class="highlight">Cet article fait le point à partir de données publiées sur les grands principes d'arrêt des hémorragies externes<strong>: </strong>Compression directe, garrot artériel en cas d'inefficacité, relatif faible niveau de preuves pour les pansements hémostatiques à utiliser néanmoins comme agent de packing de plaies, nécessité de poursuivre la recherche sur les dispositifs de compression jonctionnelle.</span></span></p><p> </p><p style="text-align: center;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><span class="highlight">ATTENTION Il s'agit de préhospitalier CIVIL</span></span></strong></p><p style="text-align: center;"><a href="http://www.naemt.org/Files/PHTLS/Bulger.evidence%20based%20prehospital%20guideline%20for%20external%20hemorrhage%20control.%20ACS%20COT.%20PEC%202014.pdf" target="_blank"><img id="media-4511783" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/00/02/1525450737.jpg" alt="PrehospTourniquet.jpg" width="372" height="233" /></a></p><p style="text-align: center;"><a href="http://www.naemt.org/Files/PHTLS/Bulger.evidence%20based%20prehospital%20guideline%20for%20external%20hemorrhage%20control.%20ACS%20COT.%20PEC%202014.pdf" target="_blank"><strong>Clic sur l'image pour accéder au document</strong></a></p><p style="text-align: justify;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlElectricité et hémorragie non compressible ?tag:citerahiadesgenettes.hautetfort.com,2014-02-18:53016012014-02-18T08:01:00+01:002014-02-18T08:01:00+01:00 Vasoconstriction by Electrical Stimulation: New Approach to Control...
<p style="text-align: center;">Vasoconstriction by Electrical Stimulation: New Approach to Control of Non-Compressible Hemorrhage</p><p style="text-align: center;"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701318/" target="_blank">Mandel Y et AL. <span class="citation-abbreviation" style="font-family: arial, helvetica, clean, sans-serif; line-height: 17.996049880981445px;">Sci Rep. </span><span class="citation-publication-date" style="font-family: arial, helvetica, clean, sans-serif; line-height: 17.996049880981445px;">2013; </span><span class="citation-volume" style="font-family: arial, helvetica, clean, sans-serif; line-height: 17.996049880981445px;">3</span><span class="citation-flpages" style="font-family: arial, helvetica, clean, sans-serif; line-height: 17.996049880981445px;">: 2111.</span></a></p><p style="text-align: justify;">Non-compressible hemorrhage is the most common preventable cause of death on battlefield and in civilian traumatic injuries. We report the use of microsecond pulses of electric current to induce rapid constriction in femoral and mesenteric arteries and veins in rats. <span style="background-color: #ffff99;"><strong>Electrically-induced vasoconstriction could be induced in seconds while blood vessels dilated back to their original size within minutes after stimulation. At higher settings, a blood clotting formed, leading to complete and permanent occlusion of the vessels</strong></span>. The latter regime dramatically decreased the bleeding rate in the injured femoral and mesenteric arteries, with a complete hemorrhage arrest achieved within seconds. <span style="background-color: #ffff99;"><strong>The average blood loss from the treated femoral artery during the first minute after injury was about 7 times less than that of a non-treated control.</strong> </span></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/00/02/4133719502.JPG" target="_blank"><img id="media-4446944" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/00/02/1571509321.JPG" alt="Electrical.JPG" /></a></p><p style="text-align: justify;">This new treatment modality offers a promising approach to non-damaging control of bleeding during surgery, and to efficient hemorrhage arrest in trauma patients</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPansement hémostatique: Restons critiques !tag:citerahiadesgenettes.hautetfort.com,2014-01-07:52649052014-01-07T07:51:00+01:002014-01-07T07:51:00+01:00 An Evidence-Based Review of the Use of a Combat Gauze...
<p style="margin-bottom: 0cm; text-align: center;" align="JUSTIFY"> <strong style="font-family: arial, helvetica, clean, sans-serif;"><strong><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">An Evidence-Based Review of the Use of a Combat Gauze (QuikClot) for Hemorrhage Control</span></span></strong></strong></p><p style="text-align: center;"><span style="color: #0000ff;"><em><span style="font-family: arial, helvetica, sans-serif;"><a href="http://www.aana.com/newsandjournal/Documents/evidenced-based-review-1213-p453-458.pdf" target="_blank"><span style="color: #0000ff;"><span style="color: #000000;">Gegel BT et Al. </span><span style="line-height: 15.953125px;"><span style="color: #660066;">Am Surg.</span></span><span style="line-height: 15.953125px;"> 2011 Feb;77(2):162-5.</span></span></a></span></em></span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;">_________________________________________________________________________</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px; font-size: small;">L'efficacité des pansements hémostatiques apparaît être une évidence. Ils sont utilisés de manière large sans véritables fondements scientiifiques prouvés. Une analyse critique s'impose, ce d'autant qu'il s'agit de produits onéreux et que l'industrie a bien façonné notre manière de raisonner. Cet article le rappelle. </span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px; text-align: center;">_________________________________________________________________________</span></p><p style="margin-bottom: 0cm;" align="JUSTIFY"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><span style="background-color: #ffff99;">Trauma is a leading cause of morbidity and mortality.</span> Uncontrolled hemorrhage related to the traumatic event is often the major cause of complications and death. <span style="background-color: #ffff99;">The use of hemostatic agents may be one of the easiest and most effective methods of treating hemorrhage.</span> The US military recommends a hemostatic combat gauze (QuikClot Combat Gauze) as the first-line hemostatic agent for use in treatment of severe hemorrhage. This review provides essential information for evidence-based use of this agent. The PICO (patient, intervention, comparison, outcome) question guiding this search for evidence was: Is QuikClot Combat Gauze, a hemostatic agent, effective and safe in controlling hemorrhage in trauma patients in the prehospital setting? The evidence appraised was a combination of lower-level human and animal research.<span style="background-color: #ffff99;"> It did not conclusively demonstrate that this combat gauze is an effective hemostatic agent for use in trauma patients, but the results are promising in supporting its use.</span> The evidence does not describe serious side effects, exothermic reaction, and thromboemboli formation associated with other hemostatic agents. Further inves tigation to determine the effectiveness of hemostatic agents, specifically QuikClot Combat Gauze, in the management of trauma casualties in the prehospital setting is required. These should include large-scale, multicenter, prehospital randomized controlled trials.</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet abdominal: En théorie cela fonctionnetag:citerahiadesgenettes.hautetfort.com,2013-12-08:52411312013-12-08T09:00:16+01:002013-12-08T09:00:16+01:00 The Evaluation of an Abdominal Aortic Tourniquet for the Control of Pelvic...
<p style="text-align: center;"><span style="color: #211e1f; font-family: Arial, Verdana, Helvetica, sans-serif; font-size: medium; line-height: 25.90625px;">The Evaluation of an Abdominal Aortic Tourniquet for the Control of Pelvic and Lower Limb Hemorrhage</span></p><p style="text-align: center;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/24183765" target="_blank"><span style="font-size: small;"><span style="color: #211e1f; font-family: Arial, Verdana, Helvetica, sans-serif; line-height: 25.90625px;">Taylor D. et Al.</span><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;"><span style="color: #660066;">Mil Med.</span></span><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;"> 2013;178(11):1196-201</span></span></a></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">Despite improved body armor, hemorrhage remains the leading cause of preventable death on the battlefield. Trauma to the junctional areas such as pelvis, groin, and axilla can be life threatening and difficult to manage. <strong><span style="background-color: #ffff99;">The Abdominal Aortic Tourniquet (AAT) is a prehospital device capable of preventing pelvic and proximal lower limb hemorrhage by means of external aortic compression.</span></strong> The aim of the study was to evaluate the efficacy of the AAT. Serving soldiers under 25 years old were recruited. Basic demographic data, height, weight, blood pressure, and abdominal girth were recorded. Doppler ultrasound was used to identify blood flow in the common femoral artery (CFA). The AAT was applied while the CFA flow was continuously monitored. The balloon was inflated until flow in the CFA ceased or the maximum pressure of the device was reached. A total of 16 soldiers were recruited. All participants tolerated the device. No complications were reported.<span style="background-color: #ffff99;"><strong> Blood flow in the CFA was eliminated in 15 out of 16 participants. The one unsuccessful subject was above average height, weight, body mass index, and abdominal girth. This study shows the AAT to be effective in the control of blood flow in the pelvis and proximal lower limb and potentially lifesaving.</strong></span></span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlGarrot abdominal: Une paire de main et des bras muscléstag:citerahiadesgenettes.hautetfort.com,2013-11-24:52291062013-11-24T08:28:00+01:002013-11-24T08:28:00+01:00 Temporization of Penetrating Abdominal-Pelvic Trauma With Manual External...
<h1 id="title0010" class="svTitle" style="border: 0px; font-size: 1.4em; margin: 0px 0px 6px; padding: 0px; vertical-align: baseline; color: #5c5c5c; line-height: 1.5em; clear: both; font-family: 'Arial Unicode MS', 'Arial Unicode', Arial, 'URW Gothic L', Helvetica, Tahoma, sans-serif; text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: medium;"><strong>Temporization of Penetrating Abdominal-Pelvic Trauma With Manual External Aortic Compression: A Novel Case Report</strong></span></h1><p style="text-align: center;"><a href="http://rescuescience.files.wordpress.com/2013/06/final-emerg-resident-research-day-eac-june-10.pdf" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Douma M et Al. </span><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;"><span style="color: #660066;">Ann Emerg Med.</span></span><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;"> 2013 Oct 23. pii: S0196-0644(13)01452-2</span></a></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; line-height: 15.953125px; font-size: small;">La prise en charge des traumatismes vasculaires de l'abdomen, du pelvis et des membres nécessite une intervention chirurgicale rapide. Il est dans ces cas nécessaire de tarir sinon de réduire le débit de saignement de telle sorte que le blessé arrive vivant dans la structure adaptée (<strong><a href="http://citerahiadesgenettes.hautetfort.com/archive/2013/06/02/hemorragies-jonctionnelles-comprimer-le-pelvis.html" target="_blank">1</a></strong>). Ceci est difficile quand les lésions ne sont pas ou difficilement garrotables notamment lors de traumatismes jonctionnels. Des équipements spécifiques ont été développé pour assurer une compression en amont des lésions et permettre de réduire ces débits de saignements. Ces dispositifs présenté par ailleurs (<strong><a href="http://citerahiadesgenettes.hautetfort.com/archive/2013/09/06/tourniquet-aortique-abdominal-compression-axillaire-5157268.html" target="_blank">2</a>, <a href="http://citerahiadesgenettes.hautetfort.com/archive/2013/04/20/hemorragie-jonctionnelle-un-nouveau-dispositif-de-compressio.html" target="_blank">3</a> , <a href="http://citerahiadesgenettes.hautetfort.com/archive/2013/02/04/le-croc-une-validation-experimentale.html" target="_blank">4</a></strong>) n'ont pas encore fait leur preuve même si des rapports isolés en soulignent l'intérêt. Certains comme les pantalons antichocs sont considérés comme ayant peu d'indications du moins mal cernées (<strong><a href="http://www.naemsp.org/Documents/Position%20Papers/POSITION-HISTORICAL%20EvalofPASGinVariousClinicalSettings-ResourceDoc.pdf" target="_blank">5</a></strong>) . Ces équipements sont rarement disponibles. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; line-height: 15.953125px; font-size: small;">Pourtant la compression abdominale bi-manuelle est possible et en fait connue depuis longtemps notamment en obstétrique sous forme de compression utérine bi-manuelle (<strong><a href="http://whqlibdoc.who.int/publications/2009/9789241598514_eng.pdf" target="_blank">6</a></strong>, <strong><a href="http://www.ncbi.nlm.nih.gov/pubmed/21676082" target="_blank">7</a></strong>, <strong><a href="http://www.ncbi.nlm.nih.gov/pubmed/7818062" target="_blank">8</a></strong>). </span></p><p style="text-align: center;"><img id="media-4339079" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/00/00/2749604893.jpg" alt="CompAbdo.jpg" /></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;"><span style="font-family: arial, helvetica, sans-serif; line-height: 15.953125px; font-size: small;">C'est ce qu'illustre le cas clinique présenté. Il existe bien sûr des facteurs limitant comme la corpulence aussi bien du blessé que du sauveteur. Il faut en effet exercer une pression abdominale </span><span style="font-family: arial, helvetica, sans-serif; font-size: small;">de l'ordre de 40 kg</span><span style="font-family: arial, helvetica, sans-serif; font-size: small;"> pour occlure l'aorte abdominal <a href="http://www.speeroptech.com/resources/Aortic_Compression_paper.pdf" target="_blank">(<strong>9</strong></a>).</span></span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPansement compressif: Un nouveau venutag:citerahiadesgenettes.hautetfort.com,2013-11-06:52151292013-11-06T21:03:00+01:002013-11-06T21:03:00+01:00 Le pansement Airwrap Il existe une grande variété de pansements...
<p style="text-align: center;"><a href="http://www.revmedx.com/#!airwrap/c1ovm" target="_blank"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">Le pansement Airwrap</span></strong></a></p><p style="text-align: justify;"><span style="font-size: small;"><span style="font-family: arial, helvetica, sans-serif;">Il existe une grande variété de pansements compressifs. L'armée française utilise le pansement dit israélien de la société Persys Medical et le pansement Olaes modular bandage de la société TacMed Solutions. En plus des bandes de compression, d'autres dispositifs on fait leur apparition visant à contrôler les hémorragies par une compression plus proximale (le CROC, le tourniquet abdominal, le SAMTourniquet, le Junctional emergency treatment too<span style="color: #000000;">l). Ces dispositifs ont recours à des dispositifs de compression. L'Aiwrap est un pansement compressif proche des pansements en dotation auquel est adjoint une vessie qui une fois gonflée va majorer de manière importante la compression sous le pansement. Son positionnement dans une gamme de produit reste à préciser.</span></span></span></p><p style="text-align: center;"><img style="margin: 0.7em 0;" src="http://static.wixstatic.com/media/14efbf_95cd5616407b692649969f202438af22.jpg_srz_p_400_300_75_22_0.50_1.20_0.00_jpg_srz" alt="14efbf_95cd5616407b692649969f202438af22.jpg_srz_p_400_300_75_22_0.50_1.20_0.00_jpg_srz" /></p><p style="text-align: center;"><img style="margin: 0.7em 0;" src="http://static.wixstatic.com/media/14efbf_66b57fee6e984da43f8e1073947de344.png_srz_p_400_300_75_22_0.50_1.20_0.00_png_srz" alt="14efbf_66b57fee6e984da43f8e1073947de344.png_srz_p_400_300_75_22_0.50_1.20_0.00_png_srz" /></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet abdominal: Compression axillaire ?tag:citerahiadesgenettes.hautetfort.com,2013-09-06:51572682013-09-06T07:59:00+02:002013-09-06T07:59:00+02:00 Clic pour accéder au document , l ire aussi
<p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/01/02/942605660.jpg" target="_blank"><img id="media-4239758" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/02/154733019.jpg" alt="AAT Axill.jpeg.jpg" /></a></p><p style="text-align: center;"><a href="http://www.compressionworks.net/resources/Case_Report_preview.pdf" target="_blank">Clic pour accéder au document</a>, l<a href="http://www.compressionworks.net/resources/AAT-JSOM-SUMMER13.pdf" target="_blank">ire aussi</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPlasma: En préhospitalier AUSSI +++tag:citerahiadesgenettes.hautetfort.com,2013-08-07:51366632013-08-07T08:08:00+02:002013-08-07T08:08:00+02:00 Point-of-injury use of reconstituted freeze dried plasma as a...
<h2 style="font-weight: normal; font-size: 20px; font-family: Tahoma, Verdana, Tahoma, Arial, sans-serif; line-height: 23px; margin: 0px 0px 7px; padding: 0px; clear: both; text-align: center;"><strong><span style="font-size: medium;">Point-of-injury use of reconstituted freeze dried plasma as a resuscitative fluid: A special report for prehospital trauma care</span></strong></h2><p id="P7" style="margin-top: 9px; margin-bottom: 9px; text-align: center;"><span style="font-size: small;"><em><span style="font-family: Verdana, Tahoma, Arial, sans-serif;"><span style="font-weight: normal;">Glassberg E. et All. J </span></span>J Trauma Acute Care Surg. 2013;75(Suppl 2):S111YS111.</em></span></p><p style="text-align: justify;"><span style="font-size: small;">La prise en charge d'hémorrragie catastrophique en phase préhospitalière est particulièrement complexe. Ces dernières années la mise en place d'un réseau structuré de prise en charge, 'application de procédures spécifiques visant à arrêter les hémorragies au plus tôt, le recours à l'acide tranexaminique, la prévention des hypothermies et l'application d'une politique raisonnée de rénaimation/chirurgie ont constitué une grande avancée. Certaines nations ont équipé leurs vecteurs d'évacuations de concentrés érythrocytaires. Le maintien d'une coagulation optimale est un enjeu majeur. Pour cela existe, entre autres, le plasma lyophilisé. Les forces armées israéliennes militent pour l'emploi de ce type de solutions en phase préhospitalière</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlConsensus statement of the ESICM task force on colloid volume therapy in critically ill patientstag:citerahiadesgenettes.hautetfort.com,2013-07-16:51229872013-07-16T22:57:00+02:002013-07-16T22:57:00+02:00 We recommend not to use HES with molecular weight C200 kDa...
<p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/02/01/1939852667.jpg" target="_blank"><img id="media-4184453" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/01/583397850.jpg" alt="hémorragie,traumatologie" /></a></p><p style="text-align: center;"> </p><p style="text-align: justify;"><span style="font-size: small;">We recommend not to use HES with molecular weight C200 kDa and/or degree of substitution[0.4 in patients with severe sepsis or risk of acute kidney injury and suggest not to use 6% HES130/0.4 or gelatin in these populations. We recommend not to use colloids in patients with head injury and not to administer gelatins and HES in organ donors. We suggest not to use hyperoncotic solutions for fluid resuscitation. We conclude and recommend that any new colloid should be introduced into clinical practice only after its patient-important safety parameters are established.</span><span style="text-align: center;"> </span></p><p style="text-align: center;"><a href="http://www.healthireland.ie/eng/about/Who/clinical/natclinprog/criticalcareprogramme/reincc.pdf" target="_blank">Accéder au consensus</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlManagement of bleeding and coagulopathy following major trauma: an updated European guidelinetag:citerahiadesgenettes.hautetfort.com,2013-07-16:51229792013-07-16T22:40:00+02:002013-07-16T22:40:00+02:00 Accéder aux recommandations
<p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/01/02/498862690.jpg" target="_blank"><img id="media-4184448" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/02/895692876.jpg" alt="hémorragie,traumatologie" /></a></p><p style="text-align: center;"><a href="http://ccforum.com/content/pdf/cc12685.pdf" target="_blank">Accéder aux recommandations</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlHémostase: L'émergence des nanoparticules ?tag:citerahiadesgenettes.hautetfort.com,2013-07-04:51140982013-07-04T08:12:00+02:002013-07-04T08:12:00+02:00 Nano hemostat solution: immediate hemostasis at the nanoscale...
<p style="text-align: center;"><strong><span style="font-size: medium; font-family: arial, helvetica, sans-serif;">Nano hemostat solution: </span><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">immediate hemostasis at the nanoscale</span></strong></p><p style="text-align: center;"><a href="http://www.artsfac.hku.hk/fmri/ufiles/files/liang/Nano%20hemostat%20solution%20immediate%20hemostasis%20at%20the%20nanoscale.pdf" target="_blank"><span style="font-size: small; font-family: arial, helvetica, sans-serif;">Ellis-Behnke RG et all. </span><span style="font-family: arial, helvetica, sans-serif; font-size: x-small;">Nanomedicine: Nanotechnology, Biology, and Medicine 2 (2006) 207 – 215</span></a></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">--------------------------------------------------------------------------------------</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Hemostasis is a major problem in surgical procedures and after major trauma. There are few effective methods to stop bleeding without causing secondary damage. We used a self-assembling peptide that establishes a nanofiber barrier to achieve complete hemostasis immediately when applied directly to a wound in the brain, spinal cord, femoral artery, liver, or skin of mammals. <strong><span style="background-color: #ffff99;">This novel therapy stops bleeding without the use of pressure, cauterization, vasoconstriction, coagulation, or cross-linked adhesives</span></strong>. The self-assembling solution is nontoxic and nonimmunogenic, and the breakdown products are amino acids, which are tissue building blocks that can be used to repair the site of injury. Here we report the first use of nanotechnology to achieve complete hemostasis in less than 15 seconds, hich could fundamentally change how much blood is needed during surgery of the future.</span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small; text-align: center;">--------------------------------------------------------------------------------------</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Dans ce modèle une hémostase obtenue en moins de 15 secondes par un mécanisme peu évident:</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">1. [<em>"</em></span><em><span style="font-family: arial, helvetica, sans-serif; font-size: x-small;">First, we know that the hemostasis is not explainable </span><span style="font-family: arial, helvetica, sans-serif; font-size: small;">by clotting. Blood clots are produced after injury, but do </span><span style="font-family: arial, helvetica, sans-serif; font-size: small;">not begin to form until 1 to 2 minutes have elapsed, depending upon the status and coagulation history of the </span></em><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><em>patient"</em>]</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">2. [<em>"</em></span><em><span style="font-family: arial, helvetica, sans-serif; font-size: x-small;">the electron micrographs show no evidence of </span><span style="font-family: arial, helvetica, sans-serif; font-size: small;">platelet aggregation at the interface of the material and wound </span></em><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><em>site"</em>]</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">3. [<em>"</em></span><em><span style="font-family: arial, helvetica, sans-serif; font-size: x-small;">We believe this tight contact is crucial to the </span><span style="font-family: arial, helvetica, sans-serif; font-size: small;">hemostatic action because of the size of the self-assembling </span></em><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><em>peptide units."</em>]</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlCroc axillaire:En théorie, c'est possibletag:citerahiadesgenettes.hautetfort.com,2013-07-02:51121682013-07-02T00:01:57+02:002013-07-02T00:01:57+02:00 Technique of axillary use of a Combat Ready Clamp to stop junctional...
<p style="text-align: center;"><span style="font-size: medium; font-family: arial, helvetica, sans-serif;">Technique of axillary use of a Combat Ready Clamp to stop junctional bleeding</span></p><p style="text-align: center;"> <strong><span style="font-size: small;"><span><span style="font-family: arial, sans-serif;"><span style="font-size: x-small;"><a href="http://dx.doi.org/10.1016/j.ajem.2013.02.027" target="_blank">Kragh JF et All. http://dx.doi.org/10.1016/j.ajem.2013.02.027</a></span></span></span></span></strong></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Bien que le Croc ne soit validé que les plaies de l'aine, son emploi au membre supérieur est possible.</span></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/02/01/1390786371.jpeg" target="_blank"><img id="media-4167467" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/01/734788497.jpeg" alt="croc.jpeg" /></a></p><p style="text-align: center;"><span style="font-size: medium; font-family: arial, helvetica, sans-serif;">Enlever la cupule et appliquer la barre de compression parallèle à la clavicule. Le serrage compotre en moyenne 5 tours.</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlHémorragies jonctionnelles: Comprimer le pelvistag:citerahiadesgenettes.hautetfort.com,2013-06-02:50873072013-06-02T23:10:00+02:002013-06-02T23:10:00+02:00 UK Combat-Related Pelvic Junctional Vascular Injuries 2008 - 2011...
<p style="text-align: center;"><span style="font-size: small;"><span style="font-weight: bold; color: #444444; font-family: arial, sans-serif; line-height: 16px; text-align: left;">UK Combat-Related Pelvic Junctional Vascular Injuries 2008</span><span style="color: #444444; font-family: arial, sans-serif; line-height: 16px; text-align: left;">-</span><span style="font-weight: bold; color: #444444; font-family: arial, sans-serif; line-height: 16px; text-align: left;">2011</span><span style="color: #444444; font-family: arial, sans-serif; line-height: 16px; text-align: left;">: </span><span style="font-weight: bold; color: #444444; font-family: arial, sans-serif; line-height: 16px; text-align: left;">Implications for Future Intervention</span><span style="color: #444444; font-family: arial, sans-serif; line-height: 16px; text-align: left;">.</span></span></p><p style="text-align: center;"><a href="http://www.bjjprocs.boneandjoint.org.uk/content/95-B/SUPP_8/13.abstract" target="_blank"><span style="color: #444444; font-family: arial, sans-serif; font-size: small; line-height: 16px;">Walker NM et All. - Bone Joint Journal (2013) vol. 95-B no. SUPP 8 13</span></a></p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; vertical-align: baseline; color: #403838; text-align: center;">---------------------------------------------------------------------------------------</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; text-align: justify; vertical-align: baseline; color: #403838;">L'arrêt d'une hémorragie jonctionnelle est un enjeu majeur. <a href="http://citerahiadesgenettes.hautetfort.com/archive/2013/01/19/hemorragies-jonctionnelles-de-quoi-dispose-t-on-en-prehospit.html" target="_blank">Plusieurs dispositifs ont été récemment proposés</a>. Il semble que la grande majorité des lésions observées se situent au dessus du ligament inguinal rendant ainsi l'efficacité de dispositif comme le CRoC limité. Le tourniquet abdominal ou le sam junctionnal tourniquet paraissent ainsi au moins théoriquement un meilleur choix si toutefois ils permettent une compression suffisante.</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; vertical-align: baseline; color: #403838; text-align: center;">---------------------------------------------------------------------------------------</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; text-align: justify; vertical-align: baseline; color: #403838;">In a recent publication, 4.6% of 6450 Coalition deaths over ten years were reported to be due to junctional bleeding. The authors suggested that some of these deaths could have been avoided with a junctional hemorrhage control device.</p><p id="p-2" style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; text-align: justify; vertical-align: baseline; color: #403838;">Prospectively collected data on all injuries sustained in Afghanistan by UK military personnel over a 2 year period were reviewed. All fatalities with significant pelvic injuries were identified and analysed, and the cause of death established.</p><p id="p-3" style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; text-align: justify; vertical-align: baseline; color: #403838;">Significant upper thigh, groin or pelvic injuries were recorded in 124 casualties, of which 92 died. Pelvic injury was the cause of death in 42; only 1 casualty was identified where death was at least in part due to a <span style="background-color: #ffff99;">vascular injury below the inguinal ligament, not controlled by a tourniquet, representing <1% of all deaths</span>. <span style="background-color: #ffff99;">Twenty one deaths were due to vascular injury between the aortic bifurcation and the inguinal ligament</span>, of which 4 survived to a medical facility.</p><p id="p-4" style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; text-align: justify; vertical-align: baseline; color: #403838;"><span style="background-color: #ffff99;">Some potentially survivable deaths due to exsanguination may be amenable to more proximal vascular control. We cannot substantiate previous conclusions that this can be achieved through use of a groin junctional tourniquet. <strong>There may be a role for more proximal vascular control of pelvic bleeding</strong>.</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlHémorragie jonctionnelle: Un nouveau dispositif de compressiontag:citerahiadesgenettes.hautetfort.com,2013-04-20:50506412013-04-20T20:02:00+02:002013-04-20T20:02:00+02:00 La prise en charge des hémorragies jonctionnelles est un des enjeux actuels...
<p style="text-align: justify;">La prise en charge des hémorragies jonctionnelles est un des enjeux actuels de la chirurgie de guerre. Réaliser une compression artérielle fémorale peut être obtenu manuellement ou bien à l'aide de dispositifs mécaniques. L'utilisation du <a href="http://www.combatmedicalsystems.net/CMS%20Croc%20Ad-1.pdf" target="_blank">Combat Ready Clamp (CRoC)</a> fait partie de la doctrine actuelle du TCCC américain. Un produit similaire est proposé: Le <a href="http://www.narescue.com/portal.aspx?CN=73330B0D4AFF" target="_blank">Junctionnal Emergency Treatment Tool (JETT)</a>. L'intérêt de ce type de dispositifs ne parait pas devoir être limité au préhospitalier. Ils sont en effet utilisés de manière courante à l'hôpital notamment pour comprimer les régions fémorales lors du retrait des dispositifs artériels fémoraux (<a href="http://reaannecy.free.fr/Documents/cardiologie/femostop.htm" target="_blank">femostop</a>). Un troisième dispositif compressif vient compléter l'offre: Le <a href="http://sammedical.com/uploads/SJT-206-BRO-2_529.pdf" target="_blank">SAM junctionnal tourniquet</a> dont l'usage semble plus simple et qui offre surtout l'avantage de réaliser une stabilisation pelvienne. (<a href="https://www.jsomonline.org/FeatureArticle/2014221Johnson.pdf" target="_blank">voir ici sa validation sur cadavre</a>)</p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/02/00/2798299872.JPG" target="_blank"><img id="media-4068422" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/00/2188503365.JPG" alt="Sam Tourniquet.JPG" /></a> </p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/02/01/628944592.jpeg" target="_blank"><img id="media-4116320" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/01/759963488.jpeg" alt="hémorragie,jonctionnel,garrot" /></a></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/01/01/29375019.jpeg" target="_blank"><img id="media-4116322" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/01/2186526394.jpeg" alt="hémorragie,jonctionnel,garrot" /></a></p><p style="text-align: center;"> </p><p style="text-align: center;"> </p><p style="text-align: center;">Cependant malgré tout leur intérêt potentiel aucun de ces produits n'a été vraiment validé </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlPour la coagulation: HEA de haut PM pas bon ?tag:citerahiadesgenettes.hautetfort.com,2013-02-21:49952062013-02-21T08:57:00+01:002013-02-21T08:57:00+01:00 Comparisons of lactated Ringer’s and Hextend resuscitation on hemodynamics...
<p style="text-align: center;"><span style="font-size: small;">Comparisons of lactated Ringer’s and Hextend resuscitation on hemodynamics and coagulation following femur injury and severe hemorrhage in pigs</span></p><p style="text-align: center;"><strong>Wenjun Z et all J Trauma Acute Care Surg. 2013;74: 732-740</strong></p><p>After traumatic hemorrhage, coagulation function was restored within 6 hours with LR resuscitation but not with Hextend. The lack of recovery after Hextend is likely caused by greater hemodilution and possible effects of starches on coagulation substrates and further documents the need to restrict the use of high-molecular-weight starch in resuscitation fluids for bleeding casualties.</p><p style="text-align: center;"><span style="font-size: small;"><strong>On rappelle que l'Hextend est un HEA<span style="color: #0a0905; font-family: 'Trebuchet MS', Tahoma, Geneva, Arial, Helvetica, 'Lucidia Sans Unicode', sans-serif; line-height: 18px; text-indent: 24px;"> 670/0.75 et que le voluven est un HEA 130/0,4 dont les effets sur la coagulation sont réputées étant moindres.</span></strong></span></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/01/01/1466740831.jpg" target="_blank"><img id="media-3982282" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/01/2433365061.jpg" alt="Hextend1.jpg" /></a></p><p style="text-align: center;"> </p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/00/00/3465467486.jpg" target="_blank"><img id="media-3982285" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/00/00/3601485461.jpg" alt="Hextend2.jpg" /></a></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/02/00/251660702.jpg" target="_blank"><img id="media-3982286" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/00/3955910437.jpg" alt="Hextend3.jpg" /></a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlHémostase et transfusion par A. Godier IAR IDFtag:citerahiadesgenettes.hautetfort.com,2012-12-02:49164932012-12-02T21:44:00+01:002012-12-02T21:44:00+01:00 CLIC sur le logo pour accéder au cours
<p style="text-align: center;"><a href="http://institut-ar.org/bin/imm/?id=401" target="_blank"><img id="media-3865186" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/00/02/2887508068.3.JPG" alt="iar.JPG" /></a></p><p style="text-align: center;">CLIC sur le logo pour accéder au cours</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlChoc hémorragique par D. Journois IAR IDFtag:citerahiadesgenettes.hautetfort.com,2012-12-02:49158382012-12-02T11:15:00+01:002012-12-02T11:15:00+01:00 CLIC sur le logo pour visualiser le cours
<p style="text-align: center;"><a href="http://institut-anesthesie-reanimation.org/spip.php?article227&dir=298" target="_blank"><img id="media-3863881" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/01/2887508068.JPG" alt="iar.JPG" /></a></p><p style="text-align: center;">CLIC sur le logo pour visualiser le cours</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlFacteur VIIa: Intérêt pas prouvé !tag:citerahiadesgenettes.hautetfort.com,2012-09-23:48429042012-09-23T23:27:00+02:002012-09-23T23:27:00+02:00 Use of recombinant factor VIIA for control of combat-related haemorrhage....
<p style="text-align: center;"><strong><span style="font-size: small;">Use of recombinant factor VIIA for control of combat-related haemorrhage.</span></strong></p><p style="text-align: center;"><a href="http://www.dtic.mil/dtic/tr/fulltext/u2/a514759.pdf" target="_blank">Woodruff SI et all. Emerg Med J 2010;27:2 121-124</a></p><p style="text-align: justify;">Ce travail met en exergue que le recours au FVIIa n'a pas d'intérêt prouvé en cas de prise en charge de traumatismes pénétrants. Ceci est d'autant plus vrai qu'il est fait alors qu'une coagulopathie sévère est installée (<a href="http://www.wjes.org/content/pdf/1749-7922-7-S1-S7.pdf" target="_blank">The utility of recombinant factor VIIa as a last resort in trauma. Mamtani R. et all. <em style="padding: 0px; margin: 0px; border: 0px; outline: 0px; vertical-align: baseline; line-height: 14.300000190734863px;">World Journal of Emergency Surgery</em><span style="line-height: 14.300000190734863px;"> 2012, </span><strong style="padding: 0px; margin: 0px; border: 0px; outline: 0px; vertical-align: baseline; line-height: 14.300000190734863px;">7</strong></a><span style="line-height: 14.300000190734863px;"><a href="http://www.wjes.org/content/pdf/1749-7922-7-S1-S7.pdf" target="_blank">(Suppl 1):S7</a>)</span></p><p style="text-align: justify;">----------------------------------------------</p><p><strong>Background </strong></p><p>Recombinant activated human coagulation factor VII (rFVIIa), an intravascular strategy to promote clotting, is being used as an adjunct to surgical control of bleeding in combat trauma patients.</p><p><strong>Objective </strong></p><p>To describe the initial experiences with rFVIIa administered to combat casualties at US Navy-Marine Corps medical treatment facilities in Iraq, and to comparesurvival outcomes of those treated with rFVIIa to controls not receiving rFVIIa.</p><p><strong>Methods</strong></p><p>Medical encounter data from the US Navy-Marine Corps Combat Trauma Registry were retrospectively reviewed to identify all battle-injured patients documented as having received rFVIIa during the period May 2004 to January 2006 of Operation Iraqi Freedom. Available clinical and injury related data are presented to characterise the patients. To assess effects of rFVIIa on survival outcomes, rFVIIa cases were matched to controls on injury severity and age.</p><p><strong>Results </strong></p><p>22 battle-injured patients from the Combat Trauma Registry received rFVIIa. Primarily young US Marines, these patients typically had penetrating injuries from improvised explosive devices and gunshot wounds. Injuries were often abdominal. The average dose used was similar to that reported in another study of civilian trauma patients, although dosing varies widely in the existing experimental and anecdotal literature. Over two-thirds (68%) of the rFVIIa patients surviveddan identical outcome seen for a matched control group of 22 patients.</p><p><strong>Conclusions</strong> </p><p>Survival of seriously injured combat casualties was good, although identical to that of a control group. Methodological limitations of this retrospective study preclude making firm conclusions about the effectiveness of rFVIIa. Future controlled studies are needed for safety and efficacy testing of rFVIIa in combat trauma patients.</p><p>----------------------------------------------</p><p> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlMoins remplir: Mieux ? Oui, MAIStag:citerahiadesgenettes.hautetfort.com,2012-09-08:48268152012-09-08T09:30:00+02:002012-09-08T09:30:00+02:00 Restrictive fluid resuscitation in combination with damage control...
<p style="margin-bottom: 0cm;" align="CENTER"><span style="font-family: arial, sans-serif;"><span style="font-size: small;"><strong>Restrictive fluid resuscitation in combination with damage control resuscitation: Time for adaptation.</strong></span></span></p><p style="margin-bottom: 0cm;" align="CENTER"><a href="http://www.ncbi.nlm.nih.gov/pubmed/22929496" target="_blank"><span><span style="font-size: x-small;"><strong>Marquinn D et all. <span>J Trauma Acute Care Surg</span><span style="font-family: AdvTT7c3c51d9;">. 2012;73: 674</span><span style="font-family: AdvP0005, serif;">-</span><span style="font-family: AdvTT7c3c51d9;">678.</span></strong></span></span></a></p><p style="margin-bottom: 0cm; text-align: left;" align="CENTER"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><strong style="font-family: arial, sans-serif; font-size: x-small; text-align: justify;">-------------------------------------------------------------------------------------------------------------</strong></span></p><p style="margin-bottom: 0cm;" align="JUSTIFY"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Ce travail confirme l'intérêt d'une stratégie de remplissage vasculaire parcimonieuse dès lors qu'une réanimation et une chirurgie spécialisée moderne sont accessibles. Le collectif des patients est ici celui de traumatisés thoraciques sévères arrivant dans une structure spécialisée dans des délais très courts. De telles conditions ne sont pas forcément celles de la prise en charge de blessés de guerre pour qui les délais d'évacuation sont souvent plus élevés. Il n'en demeure pas moins que cette publication milite pour une politique de remplissage vasculaire raisonnée. On rappelle que la procédure du sauvetage au combat donne pour objectif la perception d'un pouls radial perceptible.</span></p><p style="margin-bottom: 0cm;" align="JUSTIFY"><span style="font-family: arial, sans-serif;"><span style="font-size: x-small;"><strong>-------------------------------------------------------------------------------------------------------------</strong></span></span></p><p style="margin-bottom: 0cm;" align="LEFT"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><strong style="font-size: small; font-family: arial, sans-serif;">BACKGROUND:</strong></span></p><p style="margin-bottom: 0cm;" align="JUSTIFY"><span style="font-size: small; font-family: arial, helvetica, sans-serif;">Damage control resuscitation (DCR) conveys a survival advantage in patients with severe hemorrhage. The role of restrictive fluid resuscitation (RFR) when used in combination with DCR has not been elucidated. We hypothesize that RFR, when used with DCR, conveys an overall survival benefit for patients with severe hemorrhage.</span></p><p style="margin-bottom: 0cm;" align="JUSTIFY"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><strong style="font-size: small; font-family: arial, sans-serif;">METHODS:</strong></span></p><p style="margin-bottom: 0cm;" align="JUSTIFY"><span style="font-size: small; font-family: arial, helvetica, sans-serif;">This is a retrospective analysis from January 2007 to May 2011 at a Level I trauma center. Inclusion criteria included penetrating torso injuries, systolic blood pressure less than or equal to 90 mm Hg, and managed with DCR and damage control surgery (DCS). There were two groups according to the quantity of fluid before DCS: (1) standard fluid resuscitation (SFR)greater than or equal to 150 mL of crystalloid; (2) RFR less than 150 mL of crystalloid. Demographics and outcomes were analyzed.</span></p><p style="margin-bottom: 0cm;" align="JUSTIFY"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><strong style="font-size: small; font-family: arial, sans-serif;">RESULTS:</strong></span></p><p style="margin-bottom: 0cm;" align="JUSTIFY"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Three hundred seven patients were included. Before DCS, 132 (43%) received less than 150 mL of crystalloids, grouped under RFR; and 175 (57%) received greater than or equal to 150 mL of crystalloids, grouped under SFR. Demographics and initial clinical characteristicswere similar between the study groups. Compared with the SFR group, RFR patients received less fluid preoperatively (129 mL vs. 2,757 mL; p G 0.001), exhibited a lower intraoperative mortality (9% vs. 32%; p G 0.001), and had a shorter hospital length of stay (13 vs. 18 days; p = 0.02). Patients in the SFR group had a lower trauma intensive care unit mortality (5 vs. 12%; p = 0.03) but exhibited a higher overall mortality. Patients receiving RFR demonstrated a survival benefit, with an odds ratio for mortality of 0.69 (95% confidence interval, 0.37Y0.91).</span></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/02/00/2638270249.jpg" target="_blank"><img id="media-3736153" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/00/1269844428.jpg" alt="RFR.jpg" /></a></p><p style="text-align: center;"><strong style="font-size: small; font-family: arial, sans-serif;">CONCLUSION:</strong></p><p style="margin-bottom: 0cm;" align="JUSTIFY"><span style="font-size: small; font-family: arial, sans-serif;">To the best of our knowledge, this is the first civilian study that analyzes the impact of RFR in patients managed with DCR.</span><span style="font-size: small; font-family: arial, sans-serif; background-color: #ffff00; background-position: initial initial; background-repeat: initial initial;"> Its use in conjunction with DCR for hypotensive trauma patients with penetrating injuries to the torso conveys an overall and early intraoperative survival benefit.</span></p>
MILIQUEhttp://aumagmapresentdelecriture.hautetfort.com/about.htmlFLUIDEtag:aumagmapresentdelecriture.hautetfort.com,2012-03-10:40190742012-03-10T15:30:00+01:002012-03-10T15:30:00+01:00 FLUIDE Les pensées...
<p style="text-align: center;"><img id="media-3345045" style="margin: 0.7em 0;" title="" src="http://aumagmapresentdelecriture.hautetfort.com/media/01/01/3673013499.jpg" alt="que-etre-humaihumanise-que-souhaitez-planete_207160.jpg" /></p><p style="text-align: center;"> </p><p style="text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: medium;"><strong> FLUIDE</strong></span></p><p style="text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: medium;"><strong>Les pensées affluent, <br /></strong></span></p><p style="text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: medium;"><strong>Les sens s’aiguisent,</strong></span></p><p style="text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: medium;"><strong>Et la vie,</strong></span></p><p style="text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: medium;"><strong>Longue et secrète hémorragie, </strong></span></p><p style="text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: medium;"><strong>Défile et embrase les attentes.</strong></span></p><p style="text-align: center;"> </p><p style="text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: medium;"><strong>Comme quelque chose d’humain en sorte! </strong></span></p><p style="text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"> </p><p style="margin-bottom: 0cm; text-align: center;"><span style="font-family: arial black,avant garde; font-size: medium;"><strong>P. MILIQUE </strong></span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.html25 recommandations UK pour les traumas jonctionnelstag:citerahiadesgenettes.hautetfort.com,2011-12-13:39362142011-12-13T08:34:00+01:002011-12-13T08:34:00+01:00 http://www.medicalsca.com/files/emf_parker_junctional_trauma_jramc_2011.pdf...
<p style="text-align: center;"><a href="http://www.medicalsca.com/files/emf_parker_junctional_trauma_jramc_2011.pdf" target="_blank">http://www.medicalsca.com/files/emf_parker_junctional_trauma_jramc_2011.pdf</a></p><p style="text-align: center;">Une affaire d'équipe pour une prise en charge "aggressive" qu'il faut avoir réfléchi <strong>AVANT</strong></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlDocument SFMU: Choc hémorragique en médecine de l'avanttag:citerahiadesgenettes.hautetfort.com,2011-12-08:38985512011-12-08T08:40:00+01:002011-12-08T08:40:00+01:00 http://www.sfmu.org/urgences2011/donnees/articles/fs_conf28_art03.htm
<p style="text-align: center;"><a href="http://www.sfmu.org/urgences2011/donnees/articles/fs_conf28_art03.htm">http://www.sfmu.org/urgences2011/donnees/articles/fs_conf28_art03.htm</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlRemplissage vasculaire et ”Damage Control Resuscitation”tag:citerahiadesgenettes.hautetfort.com,2011-01-18:30702102011-01-18T09:19:00+01:002011-01-18T09:19:00+01:00 Pour compléter la note précédente, lisez la présentation proposée dans ce...
<p style="text-align: justify;">Pour compléter la note précédente, lisez la présentation proposée dans ce <a href="http://www.vinzenzgruppe.at/vinzenzgruppe/media/pdf/Fries.pdf" target="_blank"><span style="text-decoration: underline; font-size: medium;"><span style="color: #0000ff;"><strong>lien</strong></span></span></a> qui confirme le caractère relativement ténu des bases de certaines pratiques actuelles. Elle positionne le remplissage vasculaire comme un des éléments de la stratégie du "damage control resuscittaion", elle met en avant la prévention de l'hypothermie, elle rappelle les effets antiagrégants des hydroxy-ethylamidons et leur rôle néfastesur la formation du caillot de fibrine, ele rappelle l'intérêt de l'emploi d'antifibrinolytique comme l'acide tanexaminique (Exacyl) chez le traumatisé grave.</p><p style="text-align: justify;"><strong>En ce qui concerne le sauvetage au combat</strong>:</p><p style="text-align: justify;"><em><strong>la stratégie est</strong></em></p><p style="text-align: justify;">Perfuser en 20 min 250 ml de sérum salé hypertonique, suivi de 500 ml de macromolécules type VOLUVEN en cas non restauration de la perception du pouls radial et del'amélioration de la vigilence. Utiliser de l’adrénaline titrée IV (1 mg/10 ml ) en injectant ml par ml surtout si le blessé a été soumis à une explosion de forte puissance, dès la pose du second flacon de perfusion.</p><p style="text-align: justify;"><strong>Réflechissez à</strong></p><p style="text-align: justify;">La prise en charge de l'hypothermie</p><p style="text-align: justify;">L'emploi de l'exacyl qui est recommandé actuellement pour la prise en charge du polytraumatisé (<a href="http://download.thelancet.com/flatcontentassets/pdfs/S0140673610608355.pdf" target="_blank">Etude CRASH 2</a>). Une autre étude confirme un intérêt encore plus important pour la prise en charge des blessés de guerre les plus hémorragiques(<a href="http://xa.yimg.com/kq/groups/16298323/1255886318/name/Acido+tranexamico+en+combatientes,+JAMA+2011.pdf" target="_blank">Etude Matters</a>).</p><p style="text-align: justify;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlHydroxyethylamidon: Attention !tag:citerahiadesgenettes.hautetfort.com,2010-12-21:30357822010-12-21T08:51:00+01:002010-12-21T08:51:00+01:00 Cette revue de littérature rappelle quelques données essentielles sur...
<p style="text-align: justify;">Cette revue de littérature rappelle quelques données essentielles sur l'emploi des HEA pour le remplissage vasculaire. Il en ressort que le bien fondé de cette pratique n'est pas validé y compris pour les HEA de 3ème génération 130/0,4 dont fait partie le voluven pourtant les moins sujets à complications. Ces dernières sont repréesntées par le risque d'insuffisance rénale, la tendance au saignement et une tendance à l'augmentation de la mortalité. Il n'est pas sans intérêt de faire remarquer que l'HYPERHES est un soluté contennat un HEA de type 2005.</p><p style="text-align: justify;"><strong>Première lecture</strong></p><p style="text-align: justify;">REVIEW ARTICLE<br />The Efficacy and Safety of Colloid Resuscitation in the Critically Ill<br />Christiane S. Hartog, MD, Michael Bauer, MD, and Konrad Reinhart, MD</p><p style="text-align: justify;">(Anesth Analg 2011;112:156 –64)</p><p style="text-align: justify;"><br /> Despite evidence from clinical studies and meta-analyses that resuscitation with colloids or crystalloids is equally effective in critically ill patients, and despite reports from high-quality clinical trials and meta-analyses regarding nephrotoxic effects, increased risk of bleeding, and a trend toward higher mortality in these patients after the use of hydroxyethyl starch (HES) solutions, colloids remain popular and the use of HES solutions is increasing worldwide. We investigated the major rationales for colloid use, namely that colloids are more effective plasma expanders than crystalloids, that synthetic colloids are as safe as albumin, that HES solutions have the best risk/benefit profile among the synthetic colloids, and that the third-generation HES 130/0.4 has fewer adverse effects than older starches. Evidence from clinical studies shows that comparable resuscitation is achieved with considerably less crystalloid volumes than frequently suggested, namely, 2-fold the volume of colloids. Albumin is safe in intensive care unit patients except in patients with closed head injury. All synthetic colloids, namely, dextran, gelatin, and HES have dose-related side effects, which are coagulopathy, renal failure, and tissue storage. In patients with severe sepsis, higher doses of HES may be associated with excess mortality. <span style="background-color: #ffff99;">The assumption that third-generation HES 130/0.4 has fewer adverse effects is yet unproven.<span style="background-color: #ffffff;"> Clinical</span></span> trials on HES 130/0.4 have notable shortcomings. Mostly, they were not performed in intensive care unit or emergency department patients, had short observation periods of 24 to 48 hours, used cumulative doses below 1 daily dose limit (50 mL/kg), and used unsuitable control fluids such as other HES solutions or gelatins. <span style="background-color: #ffff99;">In conclusion, the preferred use of colloidal solutions for resuscitation of patients with acute hypovolemia is based on rationales that are not supported by clinical evidence. Synthetic colloids are not superior in critically ill adults and children but must be considered harmful depending on the cumulative dose administered. Safe threshold doses need to be determine in studies in high-risk patients and observation periods of 90 days. Such studies on HES 130/0.4 are still lacking despite its widespread and increasing use. Because there are safer and</span><br /><span style="background-color: #ffff99;">equally effective alternatives in the form of crystalloids, use of synthetic colloids should be avoided except in the context of clinical studies. </span></p><p style="text-align: justify;"><strong>Seconde lecture</strong></p><p style="text-align: justify;">La Société Française d'anesthésie-réanimation rappelle d'ailleurs également ce risque hémorragique y compris pour les HEA 10/0,4 notamment lors d'adminsitration aiguë.</p><p style="text-align: justify;">"<span class="normal2"><p class="spip"><span style="font-size: 12px;">L’albumine, les gélatines et l’amidon 130 000/0,4 (Voluven®) n’interfèrent pas, ou quasiment pas avec l’hémostase. <span style="background-color: #ffff99;">La prudence reste toutefois conseillée :</span><br /> - chez les patients insuffisants rénaux<br /> - en cas de perfusion prolongée ou de volume de colloïdes important ;<br /> - en cas de troubles de l’hémostase acquis ;<br /> - chez les patients traités par antiplaquettaires ou anticoagulants ;<br /> - en présence d’une anémie ou thrombopénie profonde ;<br /> - chez les patients porteurs d’une maladie de Willebrand ;<br /> - chez les patients de groupe sanguin O (ces patients ont spontanément un taux de Willebrand plus bas) ;<br /> <span style="background-color: #ffff99;">- en présence d’un saignement chirurgical actif ;</span><br /><span style="background-color: #ffff99;"> - en présence d’une transfusion massive ou d’une hypothermie.</span></span></p><p class="spip"><span style="font-size: 12px;"><strong>Comentaires</strong></span></p><p class="spip"><span style="font-size: 12px;"><strong></strong></span>Ainsi les effets secondaires des HEA ne sont pas que liés à eur adminsitration répétitive. Dans nos conditions d'emploi , il apparait nécessaire d'observer une certaine retenue dans ll'usage des HEA. Ceci plaide pour l'utilisation des solutés cristalloïdes tel que le Ringer lactate, le sérum salé hypertonique et pose la question d'un recours plus large au gélatines fluides modifiées malgré leur risque allergique (?)</p></span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlContrôler une hémorragietag:citerahiadesgenettes.hautetfort.com,2010-11-30:30081692010-11-30T00:05:00+01:002010-11-30T00:05:00+01:00
<p style="text-align: center;"> </p><p style="text-align: center;"> </p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/00/00/2436587711.JPG" target="_blank"><img id="media-2774136" style="margin: 0.7em 0;" src="http://citerahiadesgenettes.hautetfort.com/media/00/02/1196194920.JPG" alt="Sans titre4.JPG" /></a></p><p> </p><p> </p>
lafeebleuehttp://journaldunecelibataire.hautetfort.com/about.htmlHystérectomie : une semaine déjàtag:journaldunecelibataire.hautetfort.com,2010-05-27:27625912010-05-27T11:02:13+02:002010-05-27T11:02:13+02:00 Plusieurs articles sur mon hystérectomie à l'adresse ci-dessous...
<p>Plusieurs articles sur mon hystérectomie à l'adresse ci-dessous</p> <p><a href="http://recettesetnouvelles.hautetfort.com/">http://recettesetnouvelles.hautetfort.com/</a></p> <p> </p>
lafeebleuehttp://recettesetnouvelles.hautetfort.com/about.htmlHystérectomie : une semaine déjàtag:recettesetnouvelles.hautetfort.com,2010-05-27:27624862010-05-27T10:11:00+02:002010-05-27T10:11:00+02:00 Bonjour à tous. Voilà une semaine que j'ai subi une hystérectomie. Mot...
<p>Bonjour à tous.</p> <p>Voilà une semaine que j'ai subi une hystérectomie. Mot barbare que j'ai bien du mal à prononcer.</p> <p><span class="txtnoir"><span style="font-size: x-small;">L'hystérectomie est l'ablation de l'utérus. 70 000 de ces opérations ont lieu chaque année, surtout chez des femmes entre 40 et 55 ans.</span></span></p> <p><span class="txtnoir"><span style="font-size: x-small;"><span class="txtnoir">80 % des hystérectomies sont effectuées pour enlever des fibromes. Il s'agit de tissus qui se développent dans l'utérus de manière anormale. Ils ne sont pas cancéreux mais leurs conséquences sont parfois très invalidantes. Ils provoquent des douleurs gênantes dans le ventre ou des saignements abondants : <a href="http://www.france5.fr/sante/traitements/W00514/18/">http://www.france5.fr/sante/traitements/W00514/18/</a></span></span></span></p> <p><a href="http://www.docteur-benchimol.com/hysterectomie.html">http://www.docteur-benchimol.com/hysterectomie.html</a></p> <p><a href="http://www.avenirsdefemmes.com/index2.php?option=com_content&do_pdf=1&id=128">http://www.avenirsdefemmes.com/index2.php?option=com_content&do_pdf=1&id=128</a></p> <p>Par curiosité, j'ai fait des recherches sur internet. Les liens ci-dessus vous méneront vers des articles très interressant sur ce sujet.</p>
JustmarieDhttp://www.lesfemmesendisent.fr/about.htmlDans les yeux d'un angetag:www.lesfemmesendisent.fr,2007-04-01:48317192007-04-01T01:40:00+02:002007-04-01T01:40:00+02:00 Eté 2005 , alors que ma maladie était en rémission longue depuis 1993,...
<p align="justify"><strong><font color="#CC0000">Eté 2005</font></strong>, alors que ma maladie était en rémission longue depuis 1993, j'avais de violentes crises douloureuses : le bout des doigts comme passés dans un hachoir à la Pink Floyd, origine inconnue : traitement inconnu. Les consultations se succèdent, s'empilent dans ma cuisine antalgiques, antimachins, antitrucs. Le doppler n'a rien donné : je ne dois rien avoir... J'ai mal à chaque instant, plus ou moins, plutôt plus que moins. Mardi les douleurs sont devenues tellement insupportables que je perds connaissance j'appelle une amie et le médecin : j'ai le bout des doigts légèrement bleuté : "mais non je ne vois pas bleu" me répond mon futur ex-médecin : sans même m'ausculter ni même me prendre la tension il me prescrit ce jour là des anxiolytiques...le mercredi se passe....jeudi matin j'ai rendez-vous pour un contrôle cardiaque, vous avez bon coeur plaisante le médecin, oh le coeur ça va mais le bras....quoi le bras demande t'il ? j'explique, il jette un coup d'oeil sur sa montre et son agenda : revenez dans une demie-heure et je regarde...</p> <p align="justify"><strong><font color="#CC0000">Une heure plus tard</font></strong> il ballade sa sonde d'échographie en silence sur mon bras qui me paraît à cet instant être une pauvre petite chose....il descend sur le bras, en silence, puis remonte, en silence, puis redescend....les minutes sont des heures, j'ai froid. Puis les mots : c'est trés grave, c'est étrange, je ne comprends pas ce qui se passe mais c'est trés grave. Vous partez immédiatement pour Marseille, qui dois-je prévenir ?</p> <p align="justify">Je prendrai quand même le temps de rentrer à la maison, quelques affaires jetées dans un sac, un mot rassurant aux filles, une vive bataille avec les ambulanciers qui ne veulent pas emmener mon fauteuil, je pars.</p> <p align="justify"><strong><font color="#CC0000">Urgences de l'hôpital Nord</font></strong> : 7,5 de tension, mon bras est maintenant froid et engourdi on est deux dans un box de 4 m2, ma voisine vomi 6 fois dans l'heure. Aprés l'interne, le médecin : le sang ne circule plus dans votre bras on vous envoie en chir-vasculaire. Pleurer ne sert à rien, je me blinde, je mets ma carapace et laisse pudeur et sentiments devant la porte de l'hôpital, je les reprendrai en repartant, peut-être.</p> <p align="justify"><strong><font color="#CC0000">Visite du chef de ser</font><font color="#CC0000">vice</font></strong> : apparemment il y a un problème de circulation, votre bras n'est quasiment plus irrigué, c'est peut-être un syndrome blablabla dans ce cas on opère et on enlève...la première côte qui comprime peut-être l'artère.</p> <p align="justify">1- on <strong><font color="#CC0000">enlève</font></strong> la première côte ????!!! :-O</p> <p align="justify">2- qui comprime <strong><font color="#CC0000">peut-être</font></strong> re ????!!! :-O</p> <p align="justify">Mais en fait vous l'utilisez votre bras - ?????!!!!!????? (parce que sinon on vous l'enlève.......)ben oui quand même, je conduis, j'ECRIS (je mange, je caresse les cheveux de mes enfants, je sers la main de mes interlocuteurs....) tout ce qu'on fait avec sa main droite quand on est droitier ???? <strong><font color="#CC0000">ah bon d'accord alors je vais réfléchir</font></strong>......</p> <p align="justify">C'est ça, réfléchit encore un peu s'il te plaît...</p> <p align="justify">Demain on va vous faire une artériographie, le doppler a révélé un anévrisme sur toute l'artère humérale, la circulation se fait sur des réseaux secondaires qui se sont développés, vous souffrez <font color="#CC0000"><strong>depuis longtemps</strong></font> ? ben...Une artériographie consiste à introduire une sonde au niveau de l'aine, dans l'artère fémorale et à remonter jusqu'au bras pour "voir" en injectant un marqueur et en suivant sous contrôle radio. Ce n'est pas douloureux, vous aurez une anésthésie locale, <strong><font color="#CC0000">bonne nuit</font></strong>, à demain (à deux mains).</p> <p align="justify"><strong><font color="#CC0000">Je pars pour le bloc</font></strong>, une fois de plus défile au dessus de ma tête un bataillon de néons blafards, on m'a emmaillottée dans le drap : il fait froid dans les couloirs. J'ai la bouche sèche, je voudrais avoir la foi pour pouvoir m'accrocher à une prière, je prie quand même Il comprendra.</p> <p align="justify">Un mini bloc m'attend,une opératrice, une infirmière et un médecin. Il est beau gosse même sous sa charlotte, un sourire à tomber en pamoison, des yeux d'une profondeur abyssale. Il plaisante en préparant son matériel, sa voix est humainement chaude, il me parle. Je dénote dans sa voix un mélange de défiance et de stress, il a quelque chose à prouver sur cet examen primordial qui s'annonce difficile. Passée l'anésthésie locale (l'apéro) il annonce : <strong><font color="#CC0000">allez on y va, je pique respirez à fond</font></strong>. La douleur est telle que je ne peux réprimer <strong><font color="#CC0000">un cri violent</font></strong>, c'est "étonnant" d'habitude les gens ne sentent rien mais tout va bien j'ai réussi, maintenant vous ne sentirez plus rien, si vous voulez vous pouvez suivre la progression sur cet écran, ça va ?</p> <p align="justify">Je baigne dans une chaude sueur froide, mon coeur essaie de s'évader et des papillons noirs volettent sur l'écran de mon champ de vision qui a pris un ton sépia, oui ça va (je vais bien, tout va bien). Je vois sur l'écran cet alien qui remonte lentement à l'intérieur de moi, au rythme des injections se dessine la carte de mon réseau sanguin, source de vie jusqu'au delta, passage délicat du plus gros anévrisme, il semble satisfait du déroulement de l'examen, il plaisante à nouveau, demande à l'opératrice de prévenir sa petite amie d'un probable léger retard,on plaisante tous les deux à présent : je me plais à être la responsable de son retard, instant complice de courte durée : je ne me sens pas bien, j'ai des nausées, je respire mal, c'est fini dit-il, détendez-vous, plus que quelques minutes....je suis fatiguée, j'ai froid, je tourne un peu, je le dis...<strong><font color="#CC0000">encore ? allez tenez le coup ça se termine</font></strong>. Je vais enlever la sonde, je vais devoir comprimer trés fortement quelques minutes pour que l'artère se referme, respirez bien.</p> <p align="justify">Une fraction de seconde plus tard il est debout à côté de moi le poing appuyé sur le point de ponction, je hurle, je me cabre de façon incontrôlée et incontrôlable, la douleur est insoutenable, c'est tout mon corps qui se raidit contre l'agresseur, il crie à son tour : je suis obligé de le faire, je suis désolé, je ne peux pas arrêter sinon c'est l'hémorragie, je suis désolé.....<strong><font color="#CC0000">mais, imperceptiblement, sa main a relâché la pression, sa main soignante refuse de faire tant de mal, je suis désolé dit-il encore.</font></strong></p> <p align="justify">Mon corps retombe mollement sur la table comme aprés un éléctro-choc, petite poupée de chiffon, il a reculé de quelques pas, le brassard automatique me sert alors le bras....<font color="#CC0000"><strong>biiiiiiiiiip</strong></font> soudain chacun réagit, au travers du coton qui emplit alors mes oreilles je perçois quelques paroles : <strong><font color="#CC0000">tension à 5</font></strong>, il faut la regonfler, elle se vide, la sat est mauvaise...<strong><font color="#CC0000">on la perd</font></strong>. On se croirait dans un épisode d'urgences, ne manque plus que les gaz du sang, ils sont maintenant une dizaine, comme sortis de nulle part, on me parle, on parle sur moi, on parle de moi. L'ambiance est à la fois consternée, gênée et affairée, le scan est prêt annonce une voix, on me porte, on me déplace, je me surprends à penser : dans le lot il y en a bien un qui va faire quelque chose....Je suis maintenant à l'intérieur du scanner qui prend à cet instant une maline allure de cercueil, <strong><font color="#CC0000">j'y suis bien</font></strong>, je n'ai plus froid et personne ne me touche, je plane un peu, je dors peut-être. Fin du scan six personnes pour me remettre sur le brancard, attention à la perf dis-je faiblement, trop tard, ils sont six et aucun n'y a pensé : la perf est arrachée, c'est le bouquet. Le résultat du scan est sans appel il y a eu hémorragie au point de ponction, tout l'abdomen est "inondé" et même si l'artère semble refermée elle reste extrêmement fragile, il va falloir opérer pour suturer l'artére et enlever le sang qui s'est répandu : <strong><font color="#CC0000">retour au bloc</font></strong>.</p> <p align="justify">Le jeune médecin est maintenant à côté de moi, il a posé sa main sur la mienne et passe délicatement la seconde sur mon visage, ça va aller dit-il dans un souffle......instant d'humanité. Je plonge dans son regard, la mort par hémorragie interne est une mort douce.....<strong><font color="#CC0000">surtout dans les yeux d'un ange</font></strong>.</p>