Réanimation Urgences最新文献

Objective: To define the incidence and characteristics of acute poisoning by methomyl (Lannate 20 L® ingestion.

Design: Retrospective epidemiologic study based on medical records from the Hospital Sud Reunion on Reunion Island between June 1991 and March 1995.

Recruitment of cases: Any patient poisoned by ingestion of Lannate 20 L®.

Results: Fifty-six poisonings were listed, among which 42 males aged 40 ± 13.2 years old and 14 females aged 31 ± 12.5 years old. The ingested dose was estimated at 50 ml Lannate 20 L for six patients (142.8 mg/kg), and was unknown for the others. Twelve patients deceased before hospital admission. Among the 44 other victims, 25% presented a muscarinic syndrome, 27% a ganglionic nicotinic syndrome, 70% a CNS syndrome (coma) and 77.3% a respiratory distress syndrome. Thirty-six patients (82%) had a blood level of pseudocholinesterases below 2,000 UI/L. Thirty-five patients required immediate intubation and ventilation. The mean atropine dose required by 42 patients was 38.5 + 42.6 mg over the first 24 ± 33 hours. Nine patients died in the intensive care unit.

Conclusions: Poisoning by methomyl has to be treated in intensive care units. Atropine remains the first-line treatment and oximes are not yet systematically used in this indication.

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  - Neurologic control of lung vascular tone

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    • Cholinergic system:

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      - mediators

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      - muscarinic receptors

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      - mechanisms of action

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    • Non-adrenergic non-cholinergic system:

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      - definition

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      - mediators

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    • Reflex mechanisms

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    • Interactions between endothelium and neural mechanisms

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  - Humoral control of lung vascular tone

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    • Atrial natriuretic peptide

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    • Vasopressin

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    • Angiotensin-II

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    • Kinins

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    • Histamine

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    • Serotonin

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    • Free radicals:

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      - hydrogen peroxide

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      - superoxide anion

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      - peroxinitrite

Quality assurance in emergency services is now a priority for health care organizations. Assistance publique-Hôpitaux de Paris (AP-HP), the regional public hospital system for the Paris metropolitan area, performed a quality audit of its 16 emergency departments in 1996. A set of criteria and standards related to the organization and quality assurance of emergency departments was established by an expert panel and then tested in six hospitals in the AP-HP. The final version was considered as a basis for auditing the emergency department organization and quality assurance programmes. The audit was performed by a team of three trained surveyors (one physician, one hospital director and one quality manager) in each of the 16 emergency departments of AP-HP during one day. The audit was based on interviews, patient circuit analysis, documentation and procedures assessment. The results identified major differences between hospitals. The results were given to each hospital with a summary of its strengths and weaknesses. Each hospital could compare its results with those of the 15 others and develop its own quality improvement plan.

Experience from a university hospital

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  Material and methods

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  Results

Epidemiologic data Brain death diagnosis Organ donation criteria

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  Carbon monoxide and cyanide

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  Alcohols

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  Drugs

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  Substances of abuse

We report the case of 47-year-old woman with a superior vena cava syndrome occuring one month and a half after she had been equipped with a central venous catheter. Her clinical symptoms were so severe that she was treated by intravenous streptokinase administered systemically during 24 hours. This treatment provided the resolution of symptoms without any further complication. The importance of a rapid diagnosis and early treatment are discussed.