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La quête du chainon manquant 寻找缺失的链条
Q4 Medicine Pub Date : 2021-12-01 DOI: 10.1016/j.jeurea.2021.10.009
T. Schmutz, Y. Guechi, V. Ribordy
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引用次数: 0
Développer une culture qualité au Centre de Réception et de Régulation des Appels (CRRA) du SAMU de Paris 在巴黎SAMU的呼叫接收和控制中心(CRRA)发展质量文化
Q4 Medicine Pub Date : 2021-12-01 DOI: 10.1016/j.jeurea.2021.10.006
C. Dautreppe, C. Telion

Constituant la porte d’entrée du parcours de soins des patients, ce n’est que récemment que les Services d’aide médicale urgente (SAMU) ont introduit une démarche qualité dans leur organisation. Cet article présente le déploiement de cette démarche qualité mise en œuvre par le SAMU de Paris à travers le rôle clé de l’ingénieure qualité pour la réussite de la démarche. Il peut servir d’illustration de cette démarche pour les services qui auraient à s’y impliquer notamment dans le cadre de la future certification.

First step of patients care pathway, Emergency Medical Service (SAMU) have lately introduced a quality approach in their organization. This article presents this approach deployment realized in the emergency medical service of Paris (SAMU), through the pivotal role of the quality engineer to lead this project into success. This quality deployment could be an example for other services that would have to adopt this approach as part of a future certification.

作为患者护理途径的门户,紧急医疗援助服务(SAMU)最近才在其组织中引入了质量方法。本文通过质量工程师在该方法的成功中发挥的关键作用,介绍了巴黎SAMU实施的质量方法的部署。它可以作为需要参与的服务的说明,特别是在未来认证的框架内。作为病人护理途径的第一步,紧急医疗服务(SAMU)最近在其组织内引入了一种质量方针。本文介绍了在巴黎紧急医疗服务中心(SAMU)实施的这一方法,以及质量工程师在推动这一项目取得成功方面的关键作用。这种质量部署可以作为其他服务的一个例子,这些服务必须采用这种方法作为未来认证的一部分。
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引用次数: 0
Images d’hier et d’aujourd’hui de la médecine d’urgence. L’ambulance médicalisée de réanimation (AR) des années 1970 et l’unité mobile hospitalière (UMH) de 2020 昨天和今天的急诊医学图像。20世纪70年代的医疗复苏救护车(AR)和2020年的医院流动单位(UMH)
Q4 Medicine Pub Date : 2021-12-01 DOI: 10.1016/j.jeurea.2021.10.017
J.-S. Marx , J.-B. Cazalaa
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引用次数: 1
Zona ophtalmique atypique « sine herpete » en milieu hostile 在恶劣环境下的非典型眼区“正弦波”
Q4 Medicine Pub Date : 2021-12-01 DOI: 10.1016/j.jeurea.2021.10.011
L. Saint-Jean , V. des Robert , S.-P. Corcostegui , M. Marechal , J. Galant , C. Boutillier du Retail

La kératite herpétique est une forme d’herpès oculaire, elle est liée à une récurrence virale de primo-infection de l’Herpès Simplex Virus (HSV) ou du Virus Zona Varicelle (VZV) et peut toucher l’ensemble des tissus du territoire de la première branche du trijumeau (V1) : paupière, conjonctive, sclère, cornée, uvée, rétine et le nerf optique. Il s’agit d’une affection rare et grave, compte tenu de l’engagement du pronostic fonctionnel oculaire à terme. Le diagnostic est clinique, dermatologique et ophtalmologique et repose sur l’anamnèse. La prise en charge doit être précoce et associée à un suivi spécialisé étroit. Le traitement repose essentiellement sur les antiviraux, éventuellement associés à une corticothérapie locale sur avis spécialisé. Le pronostic est souvent favorable sous traitement, mais des séquelles ophtalmologiques sont possibles. Nous rapportons ici le cas d’un patient de 22 ans sans comorbidité ayant présenté une kératite herpétique inaugurale d’un zona ophtalmique atypique en milieu hostile.

Zosterian keratitis is an ocular herpes form, due to a viral recurrence of a primary infection to Herpes Simplex Virus (HSV) or to the Varicella Zona Virus (VZV) that can affect all tissues in the territory of the first branch of the trigeminal nerve (V1): eyelid, conjunctiva, sclere, cornea, uvea, retina and finally optic nerve. This is a rare and serious condition given the commitment of the full-term functional eye prognosis. The diagnosis remains clinical before the anamnestic argument beam, dermatological and ophthalmological examination. Care should be early and associated with close specialized follow-up. The treatment is mainly based on antivirals, either locally or generally, possibly associated with corticosteroids on special advice. Prognosis is often favourable under treatment, but eye sequelae could occur. We report here the case of a 22-year-old patient with no comorbidity who sufferered from an inaugural unusual zosterian keratitis of an ophthalmic zoster during hostil environnement.

疱疹性角膜炎是一种眼部疱疹复发,她与病毒性感染疱疹病毒疱疹病毒(HSV)或水痘(VZV)和整个领土的面料可触摸的第一部分中死亡(s1):流感,uvée sclère眼睑、结膜、角膜、视网膜和视神经。这是一种罕见和严重的疾病,涉及长期的眼睛功能预后。诊断包括临床、皮肤科和眼科,并基于回忆。治疗必须是早期的,并与密切的专家随访相结合。治疗主要以抗病毒药物为基础,可根据专家意见结合局部皮质治疗。治疗后的预后通常是有利的,但也可能有眼科后遗症。我们在这里报告一个病例,22岁,无合并症,在恶劣的环境中表现为非典型眼区初发疱疹性角膜炎。Zosterian keratitis is an ocular to a传递归,由于疱疹form of primary to单纯疱疹病毒(HSV)感染了黄金to the Varicella)带状疱疹病毒(VZV) that can all in the领土组织灵魂of the first branch of the nerve (s1): eyelid trigeminal conjunctiva sclere、科尼亚、uvea retina et enfin光学神经。这是一种罕见的、严重的疾病,需要全面的眼功能预测。= =地理= =根据美国人口普查,该村的总面积为,其中土地和(2.641平方公里)水。护理应尽早进行,并与密切的专门后续行动相联系。治疗主要基于抗病毒药物,无论是局部的还是一般的,可能与特殊建议的皮质类固醇有关。在治疗下预后通常是好的,但眼睛后视镜可能会出现问题。我们在此报告一名22岁无合并症患者,他在恶劣环境中罹患一种不寻常的带状疱疹角膜炎。
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引用次数: 0
Sommaire 摘要
Q4 Medicine Pub Date : 2021-12-01 DOI: 10.1016/S2211-4238(21)00133-4
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引用次数: 0
15 questions/réponses sur le « 112 » 关于“112”的15个问题/答案
Q4 Medicine Pub Date : 2021-12-01 DOI: 10.1016/j.jeurea.2021.10.013
François Braun
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引用次数: 1
Étude de faisabilité de l’évaluation de la prise en charge d’un appel au Centre 15 au SAMU de Paris 对巴黎SAMU 15中心的电话处理进行评估的可行性研究
Q4 Medicine Pub Date : 2021-12-01 DOI: 10.1016/j.jeurea.2021.10.007
C. Dautreppe, C. Telion
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引用次数: 0
Intérêts des anesthésies locorégionales périphériques en milieu périlleux 外周局部区域麻醉在危险环境中的重要性
Q4 Medicine Pub Date : 2021-10-01 DOI: 10.1016/j.jeurea.2021.09.001
P. Mahiou , R. Darren , O. Desebbe , F. Rocourt , H. Bouaziz

Traumatic injuries associated with adventure sports activities occur often in hostile environment. The regional anesthesia (RA) outside of the hospital settings has been demonstrated but not in hostile environment. So, we wondered if it was possible to carry out these RA for these very painful traumatized patients on the accident site and during their extraction-evacuation by helicoper. In a prospective observational study, 13 patients (6 women, 13 men) who benefited from a RA were included with types of accident and injuries. RA was determined and 3 situations were defined (impossible, difficult more than 1 attempt, easy to perform). Pain evaluated using visual analog scale (VAS) (0–10) measured at rescue team arrival (T0), ten minutes after RA (T10), after reduction and at helicopter evacuation. The type of accident was 14 skiing, 1 spelunking, 2 mountaineering, 1 snowshoeing, 1 paragliding and represented 11 fractures femurs, 3 legs, and 1 hand, 1 dislocation patella, 3 shoulders. Nineteen RA performed with 6 fascia iliaca blocks, 6 femoral nerve blocks, 3 interscalene blocks, 1 multiblock of nerve (median, radial, ulnar) at elbow and 3 sciatic nerve blocks. Seventeen blocks (89%) were technically straightforward and 2 (11%) difficult. Evaluation of pain showed an average VAS of 8 (7–9) before RA (T0), 1 (0–2) at T10, 0,4 (0–1) at T reduction and 0,3 (0–1) at T evacuation. All the pathologies were treated on place and helicopter evacuations were conducted in calm atmosphere. RA performed in difficult environment is feasible, effective and reproducible in extreme conditions. There is no limitation due to hostile terrain. RA techniques used must simple and fast but performed by trained physicians who are technical experts in order achieve a successful outcome in difficult terrain.

与冒险运动相关的创伤性损伤经常发生在敌对环境中。区域麻醉(RA)在医院外的设置已经证明,但不是在敌对环境。因此,我们想知道是否有可能在事故现场为这些非常痛苦的创伤患者以及在直升机的撤离过程中实施这些RA。在一项前瞻性观察研究中,13例受益于RA的患者(6名女性,13名男性)被纳入事故和伤害类型。确定RA,并定义3种情况(不可能、困难1次以上、容易执行)。使用视觉模拟评分(VAS)(0-10)评估在救援队到达时(T0)、RA后10分钟(T10)、复位后和直升机疏散时的疼痛。事故类型为滑雪14例,洞穴探险1例,登山2例,雪鞋行1例,滑翔伞1例,股骨骨折11例,腿部骨折3例,手部骨折1例,髌骨脱位1例,肩部骨折3例。19例RA采用髂筋膜阻滞6例,股神经阻滞6例,斜角肌间阻滞3例,肘部多神经(正中、桡、尺)阻滞1例,坐骨神经阻滞3例。17个区块(89%)技术简单,2个区块(11%)技术困难。疼痛评估显示,RA前(T0)的平均VAS为8 (7-9),T10时为1 (0 - 2),T复位时为0,4 (0 - 1),T清除时为0,3(0 - 1)。所有的病症都在现场治疗,直升机在平静的气氛中进行了撤离。在困难环境下进行的RA在极端条件下是可行、有效和可重复性的。不受恶劣地形的限制。使用的RA技术必须简单快速,但必须由训练有素的技术专家医师执行,以便在困难地形中取得成功。
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引用次数: 0
Et si c’était un choc à la Bétadine® ? 如果是碘伏®的冲击呢?
Q4 Medicine Pub Date : 2021-10-01 DOI: 10.1016/j.jeurea.2021.05.008
O. Barbier , J. Goret , M. Bordes , C. Pellerin , S. Guez

Les principaux agents responsables des réactions anaphylactiques peropératoires sont bien connus. Cependant lorsque le bilan allergologique initial est négatif, des explorations complémentaires doivent être réalisées afin d’identifier un nouvel allergène potentiel comme les antiseptiques. Nous présentons un cas de choc anaphylactique peropératoire rapporté à la Bétadine®.

The main causative agents for intraoperative anaphylactic reactions are well known. However, when the initial allergic assessment is negative, additional explorations must be carried out in order to identify a potential new allergen such as antiseptics. We present a case of intraoperative anaphylactic shock to Betadine®.

术中过敏反应的主要原因是众所周知的。然而,如果最初的过敏评估是阴性的,则需要进行额外的检查,以确定新的潜在过敏原,如防腐剂。我们报告了一例与碘伏®相关的术中过敏性休克。手术中过敏反应的主要致病因子是众所周知的。然而,当最初的过敏评估呈阴性时,必须进行进一步的探索,以确定潜在的新过敏原,如防腐剂。我们介绍了一例碘伏®术中过敏性休克。
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引用次数: 1
Prise en charge d’un traumatisme thoracique sévère par l’application de Quick Clot Combat Gauze 使用快速血块战斗纱布治疗严重胸部创伤
Q4 Medicine Pub Date : 2021-10-01 DOI: 10.1016/j.jeurea.2021.06.003
J. Schmitt , J. Bordes , G. Lacroix , J.-P. Avaro , E. Meaudre

La prise en charge des saignements massifs du médiastin postérieur chez les patients traumatisés sévère réside en une chirurgie de type damage control ou bien une artério embolisation. Nous rapportons le cas d’un traumatisé sévère présentant une burst fracture rachidienne compliquée d’un hémothorax massif nécessitant l’utilisation de compresses hémostatiques (Quick Clot Combat Gauze). Une telle prise en charge a déjà été décrite lors d’expériences animales ou bien exceptionnellement lors de cas cliniques. Les compresses hémostatiques pourraient être une alternative en cas d’hémostase chirurgicale difficile, mais leur usage intracorporel a besoin d’être étudié au travers d’essais randomisés contrôlés.

Management of life-threating posterior mediastinum hemorrhage in trauma patients patient consists in embolization or damage control surgery. Here we report a case of a trauma patient presenting a traumatic burst fracture with a massive hemothorax requiring hemostatic pads compression (Quick Clot Combat Gauze). Such a trauma management has been described in animal studies, and exceptionally in case reports. Hemostatic pads seem to be an alternative way to perform surgical hemostasis, but its intracorporeal use needs to be confirmed by further randomized control studies.

严重创伤患者中纵隔后大量出血的治疗方法是损伤控制手术或动脉栓塞。我们报道了一个严重创伤的病例,伴有伴有大量血胸的椎间盘破裂和骨折,需要使用止血布(快速血块对抗纱布)。这种管理已经在动物实验或临床病例中被描述过。止血按压可能是困难手术止血的一种选择,但它们的体内使用需要通过随机对照试验进行研究。创伤患者危及生命的纵深后出血的管理患者包括栓塞或损伤控制手术。在这里,我们报告了一个创伤患者的创伤性破裂性骨折,血胸大,需要用止血垫压缩(快速血块对抗纱布)。= =地理= =根据美国人口普查,这个县的面积为。止血垫似乎是进行手术止血的一种替代方法,但其在体内的使用需要进一步的随机控制研究来证实。
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引用次数: 0
期刊
Journal Europeen des Urgences et de Reanimation
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