L’impact des changements climatiques sur la nutrition des jeunes salmonidés

Licenc

Prise en charge du traumatisé grave (évaluation des pratiques au SMUR de Bordeaux, étude d'août 2009 à juillet 2010)

Notre étude a rassemblé les fiches de régulation et les feuilles d'intervention médicale (FIM) des patients traumatisés graves âgés de plus de 18 ans, victimes d'un accident de la circulation et pris en charge par le SMUR de Bordeaux entre le 1er août 2009 et le 31 juillet 2010. Elle recense 118 interventions (82 hommes et 36 femmes : âge moyen 38,5 ans) : 27 patients présentent un ACR à la prise en charge initiale du SMUR (dont 26 non récupérés, taux de survie 3,7 %), 25 un traumatisme crânien grave, 8 un traumatisme vertébro-médullaire, 12 un choc hémorragique traumatique isolé, 47 un traumatisme grave autre. 91 patients survivent. Tous les patients non décédés sont admis à l'hôpital Pellegrin, dont près de 95 % en SAUV. 91 patients bénéficient d'un monitorage associant cardioscope, saturométrie pulsée et pression artérielle non invasive, 6 ont une mesure de la température corporelle au début et à la fin de la prise en charge. 57 patients bénéficient d'une analgésie et 27 d'au moins une évaluation du niveau de la douleur. 53 patients ont une intubation endotrachéale dont 37 après ISR standard. 62 patients nécessitent un remplissage vasculaire, près de la moitié avec un volume supérieur à 1000 mL. 24 requièrent l'administration de catécholamines, 7 sont transfusés avec des culots globulaires. La discussion porte sur la rédaction des FIM, le monitorage du patient, la prise en charge de la douleur, des détresses circulatoire et/ou respiratoire et enfin sur l'orientation des patients. La prise en charge des détresses circulatoire et/ou respiratoire et l'orientation des patients sont en adéquation avec les référentiels en vigueur. En revanche la rédaction des FIM, le monitorage de la température corporelle, et l'évaluation de la douleur doivent être améliorés. Une étude prospective pour évaluer les pratiques professionnelles est nécessaire.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Evaluation de l'application du protocole d'induction en séquence rapide pour l'intubation trachéale en préhospitalier

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Accidentologie de la randonnée pédestre en moyenne montagne en Pays Basque Nord (perspectives de prévention)

INTRODUCTION : Hiking in basque mountains has grown rapidly. It participates in the transformation of socio-economic activities and recreation of the past 30 years. This is a low-supervised activity (only 2 % is member of a federation). There is few studies about this. They mainly concern high mountains. The aim of the study is to demonstrate the specificity of the basque medium altitude mountain accidents in order to adapt prevention. METHOD : Descriptive study of summer time hiking accidents occured in the rescue area and based on the data of Bayonne's SAMU/EMS. A phone survey complete the study to assess the experience and equipment of injured or ill hikers. RESULTS / DISCUSSION : 140 casualties : 82 % of all accidents in basque mountain. The hiking is the main issue of prevention in the medium elevated mountains. Specificity : older population (> 50 years = 64 %), majority of women, significant part of medical accidents (34 %), medical illness has highest severity than trauma injuries (18 % vs 8 %), role of local fire brigades (44 % of rescue operations). Difficulties of regulation and underestimation of the severity of medical illness. The study of the experience and equipment enables to follow the effects of prevention. It shows here the failure of the main accident prevention french campaign : 55 % is under-equipped, 60 % has no respect for safety instructions. The importance of medical illnesses and the experience assessment reflects the features of the visitors : relatively inactive urban population, unfamiliar with the wilderness. CONCLUSION : A better understanding of the accident in basque medium altitude mountains should allow care providers to improve their emergency management. Prevention must be part of the development projects of the basque mountains : Sustainable Development Charter of the Basque Mountain.SAR-HITZA : Ipar Euskal Herriko goratasun ertaineko mendi ibilaldiak gero eta garatuagoak dira. Azken 30 urteotan, mendiko aldaketa sozio-ekonomikoak bultzatu egin ditu. Ibilaldi jarduerak koadro berezia eskas du (% 2 a soilik federatua da). Eskasak ere berari buruzko ikerketak, goi mendia ikertzen baita gehien. Maila ertaineko mendi ibilaldi istripuen berezitasuna frogatu nahi izan dugu, prebentzioa egokitzeko xede. METODOA : udako mendi ibilaldi istripuei buruzko ikerketa deskribatzailea. Baionako SAMUko datuetan oinarritua. Telefonoz egin inkestak ikerketa osatzen du, esperientzia eta ekipamenduaren ebaluazioa egiteko asmoz. EMAITZAK / EZTABAIDA : 140 kolpatu - mendiko istripuen % 82 a. Ibilaldi jarduera da maila ertaineko mendietako prebentzioaren erronka nagusia. Tipologi berezia : populazio zaharragoa (> 50 urte = % 64 a), gehienik emakumezkoak, patologia medikoaren garrantzi berezia (% 34 a), horren larritasuna, patologia traumatikoari konparatuz (% 18 a vs % 8 a), tokiko suhiltzaileen garrantzia (esku-hartzeen % 44 a). Erregulazioaren zailtasunak, patologia medikoaren larritasuna arinagotzat jotzea. Esperientzia eta ekipamenduaren ebaluazioa prebentzioaren eragina neurtzeko tresna da. Erakusten du "mémento" aren prebentzio kanpainaren hutsegitea : % 55 ak ekipamendu eskasa du, % 60 ak segurtasun arauen errespetu eskasa du. Esperientziaren neurketa eta patologia medikoaren garrantziak erakusten dute maila etaineko mendizale populazioaren izaera nagusia : hiritar, sedentario, mendi ingurumenarekin usaiarik gabeak. KONKLUZIOA : maila ertaineko mendiko istripu fenomenoaz ongi jabetuz gero, sorospenaren eragileen esku-hartzea hobetuko liteke. Prebentzioa euskal mendiaren garapen proiektuetan baitan kokatu behar da : Euskal Mendiaren Garapen Iraunkorrerako Ituna.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Biochemical testing in a laboratory tent and semi-intensive care of Ebola patients on-site in a remote part of Guinea: a paradigm shift based on a bleach-sensitive point-of-care device.

BACKGROUND: During the West Africa Ebola virus disease (EVD) outbreak, a Belgian laboratory was deployed for supporting the Ebola treatment unit (ETU) of N'Zerekore, Guinea. Besides diagnosis of EVD and malaria, biochemical parameters were tested and used to guide supportive treatment of EVD. METHODS: To preserve analytes stability, lithium-heparin blood samples were analyzed using the i-STAT® point-of-care testing (POCT) handheld device without the viral inactivation step. To mitigate the risk of Ebola virus transmission, assays were performed inside a portable glovebox with strict biosafety procedures. RESULTS: Providing the medical staff with real-time biochemical data modified their therapeutic attitude, shifting from empiric to a semi-intensive laboratory-guided treatment of hydro-electrolytic disturbances, metabolic acidosis and/or impaired kidney function. As illustrated with representative EVD cases (n=8), optimized supportive treatment with intravenous fluid therapy and electrolyte replacement often helped correct these abnormalities. However, the harsh operating conditions, especially the use of bleach decontamination inside the glovebox, caused several technical failures and the final breakdown of the POCT device. CONCLUSIONS: POCT availability resulted in a paradigm shift in laboratory practice and care delivery at the N'Zerekore ETU. We conclude that there is urgent need for novel well-designed and validated POCT devices usable by non-expert operators in high ambient temperature and limited space. These devices should withstand regular and thorough decontamination by the personnel working on-site with life-threatening pathogens and be compatible with high biosafety level procedures. Such specific users' requirements need a European validation and standardization process of proposed solutions led by the EU Standardization Committee (CEN)

Aerial medical evacuation of health workers with suspected Ebola virus disease in Guinea Conakry-interest of a negative pressure isolation pod-a case series

We report 4 cases of Health Workers (HW) suspected of having contracted Ebola Virus Disease (EVD), transported from the Alliance for International Medical Action (ALIMA) Ebola Treatment Centre (ETC) in N'Zerekore, Guinea to the Treatment Centre for Carers run by the medical corps of the French army in Conakry, the capital of Guinea, which was established on 17 January 2015 and closed on 7 July 2015. In total more than 500 HWs have died from EVD since the epidemic began. This mortality has had significant effects on the ability of local services to respond appropriately to the disaster. The HWs were transported by air in the "Human Stretcher Transit Isolator-Total Containment (Oxford) Limited" (HSTI-TCOL) negative pressure isolation pod. Medical evacuation of patients with suspected, potentially fatal, infectious diseases is feasible with the use of a light isolator for patients without critical dysfunctions

Multiparameter analysis of vascular remodeling in post-acute sequelae of COVID-19

International audienceThe COVID-19 infection, a current worldwide health concern, manifests as an alveolar-interstitial pneumonia with unknown long-term evolution. It is also associated with vascular dysfunction and shows a vascular remodeling with a changed balance between small-and large-caliber vessels. In this study, we question the existence of residual vascular alteration in post-acute sequelae of COVID-19 (PASC) by investigating possible associations between vascular remodeling biomarkers extracted from CT and functional, radiological and morphological parameters. The used vascular biomarkers concern the blood volume ratio of vessels with cross-section area inferior to 5 mm 2 versus vessels of crosssection area inferior to 50 mm 2 (BV5/BV50), an index of local peripheral vascular density and a peripheral composite vascular remodeling index, both measured in the antero-postero-lateral lung periphery (excluding mediastinal region). As a functional parameter, diffusing capacity of the lung for carbon monoxide (DLCO) is a measure depending on the vascular perfusion and the amount of interstitial thickening, a decreased DLCO value suggesting altered vascular perfusion. Imaging biomarkers can be extracted from the analysis of perfusion lung scintigraphy or CT scan. Some of them are included in our study. Radiological features include CT attenuation as a measure of persistence of ground glass opacity and development of changes suggestive to look for fibrosis, such as reticulations. As additional morphological parameter, lung deformation observed between inspiration/expiration maneuvers may be suggestive of the presence of reticulations inducing lung stiffness and breathing deficiency. The investigation of associations between vascular remodeling biomarkers obtained from CT and the above functional, radiological and morphological parameters revealed moderate to strong correlations highlighting the ability to capture the persistence of vascular alterations in PASC in relation with the development of fibrotic patterns, which is a promising direction for future research