Annales françaises d'anesthèsie et de rèanimation
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War wounds usually show abundant devitalized tissue and often contain foreign material (environmental matter, shrapnels, and bullets). Thus, they are particularly prone to infection. Moreover, evacuation to a medical treatment facility and surgical debridement are often delayed due to tactical constraints. ⋯ If oral administration is excluded (unconsciousness, penetrating abdominal trauma, shock), the parenteral administration will be delayed until the patient has been taken in charge by medical or paramedical personnel. In that case, the intravenous administration of an association of an ureidopenicilline with antibacterial activity against Pseudomonas and a ß-lactamase-inhibitor at high doses could be a rational choice (piperacilline 4 g+tazobactam 0.5 g) (Tazocilline®). An antibiotic treatment beyond the time of surgery may become necessary in individual patients depending on the local features of the wound and should be prescribed by the medical officer in charge of the patient on a case-by-case basis.
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Ann Fr Anesth Reanim · Feb 2012
Review[Cricothyrotomy for airways management: current data and interest for combat casualty care].
To detail current data in cricothyrotomy and imperatives of airway management in combat casualty care. ⋯ This review of literature and the analysis of commercial kits prompt us to suggest safe methods that can be performed on battlefield. Surgical methods and MiniTrach II kit (Portex) seem to be particularly suitable for battlefield situations. An airways management algorithm for combat casualty care is also proposed.
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Ann Fr Anesth Reanim · Jan 2012
Review[Peroperative anaphylactic shock in children: management and evaluation].
Anaphylactic shock is the most severe manifestation of hypersensitivity, whether of allergic origin or not. In the operating theatre, anaphylactic shock is rare in paediatric patients and latex allergy is still the major cause of allergy. ⋯ Symptomatic treatment is well codified. The results of blood sampling at the time of the reaction and of allergic tests performed a few weeks later will enable a definitive diagnosis to be made and appropriate recommendations (medical alert card) to be given to the patients and its parents.
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Ann Fr Anesth Reanim · Jan 2012
Review[Neurological consequences after long-term sedation in the ICU].
Experiments performed in mammals, including non-human primates, have demonstrated an increase in neuronal death rates normally seen in normal brain development. Such an increase is encountered in diseases but also after exposure of the brain to various class of anaesthetics. In living animals, it can (but not always) result in persistent cognitive impairment. ⋯ Second, it is known for years than anaesthesia before 1 year of age is much riskier than after 1 year, whatever the theorical neurotoxicity is. Third, this enforces the need to develop tools enhancing the precision of anaesthesia as much as possible. Meanwhile, when an infant has undergone numerous general anaesthesias, we strongly recommend a long-time neurological follow-up.
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Ann Fr Anesth Reanim · Jan 2012
Review[Out-of-hospital management of elderly patients for trauma injury].
Elderly patients should benefit from maximum care in cases of serious trauma, starting with pre-hospital care. A proper evaluation of the gravity of the trauma is an essential element in the management. The elderly are at risk of "under-triage", which can result in inappropriate hospital admission and delayed trauma care. ⋯ Locoregional anaesthesia should be used when possible in this setting, in particular the ilio-facial block. Age is not a criterion for a non-resuscitation order in trauma patients. The decisions of limitation of therapeutic, if they were not anticipated, will be discussed after admission, according to the principles of the current legislation.