Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · Apr 2000
Case Reports[Cerebral arterial air embolism associated with pneumothorax in a patient with pressure support ventilation].
A 20-year-old woman was admitted to the ICU following a road traffic accident. She had a periorbital haematoma with a normal cerebral state on CT-scan, intrahepatic and intrasplenic haematomas and several fractures of the limb that were fixed on day 3. Twenty-four hours later, she developed a cough with symptoms of decerebration The head CT-scan showed diffuse pneumocephalus suitable with cerebral air embolism and the chest X ray a right tension pneumothorax. ⋯ Despite the lack of hyperbaric oxygen therapy the patient recovered fully. The pneumocephalus disappeared totally after 48 hours. Seven days later, CT-scan of the head with coronal slides showed an orbital floor fracture associated with an intra-orbital aerocele.
-
Ann Fr Anesth Reanim · Apr 2000
[Fiberoptic bronchoscopy during noninvasive positive-pressure ventilation in patients with chronic obstructive lung disease with hypoxemia and hypercapnia].
To assess the feasibility and safety of non invasive positive-pressure ventilation (NIPPV) via a face mask to performing fiberoptic bronchoscopy (FOB) in patients with COPD contraindicating FOB in spontaneous ventilation. ⋯ Application of NIPPV during FOB is a safe technic for maintaining adequate gas exchange in hypoxaemic and hypercapnic COPD patients not in acute respiratory failure. After the end of the procedure a close surveillance in the intensive care unit is essential.
-
Ann Fr Anesth Reanim · Apr 2000
Review[Management of severe head injuries during the first 24 hours, in the emergency department, in neurosurgery].
In France, the role of the neurosurgeon in the emergency department depends on local health care policies and geographical constraints. Some departments include a neurosurgical team with a dedicated operating room. In others, a neurosurgeon can be reached by phone, possibly with an image transfer. ⋯ The management of a haematoma of the posterior fossa or a bleeding dural venous sinus would be difficult for a surgeon not qualified in neurosurgery. The optimal situation is the presence of a neurosurgeon in the medical team admitting patients with a severe head or spine trauma, for assessment of the neurological status, or interpretation of radiological explorations, insertion of an intracranial pressure monitoring device. Besides the extradural haematoma, other injuries such as an acute subdural haematoma, a haematoma associated with a contusion, an acute hydrocephalus, a depressed fracture of the skull, or a craniocerebral wound, also require an emergency decompressive procedure.
-
Ann Fr Anesth Reanim · Apr 2000
Review[Role of the regulation in the management of patients with severe head injuries].
The regulator of the emergency medical ambulance service is involved in the various steps of the initial management of severe head trauma patients: handling calls, basic life support, prehospital advance life support, transport and hospital admission. The management is rapid (helicopter transports) coherent and adapted (adherence to the guidelines for severe head injury), and considers of local difficulties (geographical, possibility of admission to trauma centres), with the aim of improving the outcome of severely head-injured patients.
-
Traumatic brain injury (TBI) constitutes a major health and economic problem for developed countries, being one of the main causes of mortality and morbidity in children and young adults. Because of the immense importance and future consequences of TBI, the physician who sees a patient soon after brain injury must have a complete understanding of the pathophysiology and develop a practical knowledge of initial management of such patients. TBI may have intracranial and systemic effects that combine to give overall cerebral ischaemia. ⋯ The concept of 'cerebral protection' has been extended to encompass pretreatment of secondary injury. Preventing and treating cerebral ischaemia is the main goal of initial management of head-injured patients. Initial care focuses on achieving oxygenation, airway control and treatment of arterial hypotension.