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Biomedical subjects

F Adnet

Publications and source records attributed to F Adnet.

At least 55 records · Page 3Linked to original sources
PubMed2000

Radiopacity of clomipramine conglomerations and unsuccessful endoscopy: report of 4 cases.

BACKGROUND: The radiopacity of ingested substances may serve as a clue to the presence of particular compounds, as this characteristic varies considerably among medications and household products. Tablet conglomerations are also variably radiopaque. We report 4 cases of clomipramine poisoning associated with formation of radiopaque masses, believed to be clomipramine, in the area of the stomach. CASE REPORTS: Four patients were admitted to the Toxicological Intensive Care Unit after ingestions of, respectively, 8.5 g (180 tablets of mixed strength), 7.5 g (100 tablets), 10.5 g (140 tablets), and 4.5 g (60 tablets) of clomipramine, along with other sedatives and antipsychotics. In each case, a rounded density was observed in the gastric area on plain chest radiograph. The hospital courses of each patient were marked by tachycardia, hypotension, QRS and QT prolongation, seizures, and decreased mental status. Three of 4 patients underwent unsuccessful endoscopy to remove tablet fragments and subsequently suffered gastrointestinal hemorrhage requiring transfusion. All patients were discharged recovered from the hospital. DISCUSSION: Clomipramine, a potent tricyclic antidepressant, has been previously reported to be nonradiopaque, and has not been reported to induce formation of concretions. These cases suggest that massive ingestions of clomipramine may form bezoars which are radiopaque and may be associated with serious toxicity. Careful consideration should be given prior to the use of gastric endoscopy for the retrieval of tablet fragments since significant hemorrhage, attributed to the procedure itself rather than to clomipramine toxicity, may ensue.

Acepromazine↗
PubMed1999

A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest. French Active Compression-Decompression Cardiopulmonary Resuscitation Study Group.

BACKGROUND: We previously observed that short-term survival after out-of-hospital cardiac arrest was greater with active compression-decompression cardiopulmonary resuscitation (CPR) than with standard CPR. In the current study, we assessed the effects of the active compression-decompression method on one-year survival. METHODS: Patients who had cardiac arrest in the Paris metropolitan area or in Thionville, France, more than 80 percent of whom had asystole, were assigned to receive either standard CPR (377 patients) or active compression-decompression CPR (373 patients) according to whether their arrest occurred on an even or odd day of the month, respectively. The primary end point was survival at one year. The rate of survival to hospital discharge without neurologic impairment and the neurologic outcome were secondary end points. RESULTS: Both the rate of hospital discharge without neurologic impairment (6 percent vs. 2 percent, P=0.01) and the one-year survival rate (5 percent vs. 2 percent, P=0.03) were significantly higher among patients who received active compression-decompression CPR than among those who received standard CPR. All patients who survived to one year had cardiac arrests that were witnessed. Nine of 17 one-year survivors in the active compression-decompression group and 2 of 7 in the standard group, respectively, initially had asystole or pulseless electrical activity. In 12 of the 17 survivors who had received active compression-decompression CPR, neurologic status returned to base line, as compared with 3 of 7 survivors who had received standard CPR (P=0.34). CONCLUSIONS: Active compression-decompression CPR performed during advanced life support significantly improved long-term survival rates among patients who had cardiac arrest outside the hospital.

Cardiopulmonary Resuscitation↗
PubMed1999

Relation of body position at the time of discovery with suspected aspiration pneumonia in poisoned comatose patients.

OBJECTIVE: The left lateral decubitus position is generally accepted as the position of choice to protect against aspiration pneumonia in comatose poisoned patients. We studied the relationship between initial body position during coma and subsequent development of suspected aspiration pneumonia (SAP). DESIGN: Observational, descriptive study. SETTING: Toxicology intensive care unit in a university hospital. PATIENTS: Acutely poisoned comatose patients admitted to our intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Glasgow Coma Scale score (GCS) and body position were recorded in poisoned patients on discovery. Chest radiographs were examined for infiltrates suggesting SAP within 24 hrs of hospitalization. The prone positioned patients had a lower incidence of SAP than patients in the lateral decubitus and supine positions, despite similar GCS scores. Patients in the semi-recumbent position had an incidence of SAP similar to prone patients, but with higher GCS values. CONCLUSIONS: The prone position appears to be associated with a lower incidence of SAP than the lateral decubitus position in comatose poisoned patients.

Acute Disease↗
PubMed1998

Emergency tracheal intubation of patients lying supine on the ground: influence of operator body position.

PURPOSE: To evaluate the influence of operator body position during emergency intubation of patients lying on the ground. METHODS: This study was carried out in the prehospital setting by French mobile intensive care units. Two operator body positions (left lateral decubitus and kneeling) for emergency intubation of patients lying supine on the ground were compared in a observational prospective study. Each operator completed a questionnaire regarding conditions of intubation after patient completion. RESULTS: The incidence of laryngoscopic difficulty was lower in the left lateral decubitus group compared to the kneeling group (11.1% vs 26.9% respectively; P < 0.01). The number of attempts required for successful intubation was (P < 0.05) higher in the kneeling group than in the left lateral decubitus group. CONCLUSION: Emergency tracheal intubation of supine patients on the ground may be greatly facilitated by the use of the left lateral decubitus position of the operator.

Adolescent↗
PubMed1998

Prolonged severe hypercapnia complicating near fatal asthma in a 35-year-old woman.

OBJECTIVE: We describe a patient with a prolonged and severe hypercapnia occurring during an episode of status asthmaticus induced by ophthalmic instillation of carteolol. SETTING: Prehospital Emergency Medical Service and Pulmonary Intensive Care Unit in a university hospital. PATIENT: A 35-year-old female developed an acute asthma attack while at home, which required advanced life support. INTERVENTION: On hospital admission, arterial blood gases revealed a PaCO2 of 208 mmHg. Hypercapnia persisted with a PaCO2 of more than 190 mmHg for 10 h, with pH always less than 7.00. The patient was finally discharged after 26 days without sequelae. CONCLUSION: This case illustrates the cerebral and cardiovascular tolerance of severe and prolonged hypercapnia associated with major acidosis.

Acidosis, Respiratory↗
PubMed1998

Survey of out-of-hospital emergency intubations in the French prehospital medical system: a multicenter study.

STUDY OBJECTIVE: To determine the clinical characteristics of endotracheal intubation in the French emergency prehospital medical system and compare these data with those of other systems. METHODS: This study was performed in lle de France (Paris Region) in mobile ICUs staffed by physicians. This prospective, descriptive study involved completion of a questionnaire by the operator just after endotracheal intubation was performed. RESULTS: Six hundred eighty-five (99.1%) of 691 consecutive prehospital intubations were performed successfully in the field. The orotracheal route was used in 96.0%, and no surgical approaches such as cricothyroidotomy were used. Mechanical complications occurred in 84 patients, at a rate of 15.9% for nonarrest patients and 8.1% for arrest patients. A wide variety of sedation protocols were used. Difficult intubations (10.8%) were comparable in incidence to the number seen in US emergency departments, not US prehospital systems. By the same token, intubation success rates (99.1%) were comparable to US EDs and much higher than US prehospital results. CONCLUSION: The characteristics of French prehospital airway management differ significantly from those of other countries. These differences may be explained by differences in approach to prehospital management rather than differences of skill.

Clinical Protocols↗
PubMed1998

[Rapid sequence anesthetic induction via prehospital tracheal intubation].

The choice of sedation for emergency intubation remains controversial. This lack of consensus has led to various sedation protocols used in French prehospital care setting. A review of data from the literature suggests that the association etomidate-suxamethonium is probable the best choice for rapid sequence intubations in the prehospital setting. Its benefits include protection against myocardial and cerebral ischaemia, decreased risk of pulmonary aspiration, and a stable haemodynamic profile. Randomized studies are needed to substantiate the advantages of the association etomidate-suxamethonium for rapid sequences intubation in the prehospital setting.

Anesthesia, Endotracheal↗
PubMed1998

Intubation difficulty in poisoned patients: association with initial Glasgow Coma Scale score.

OBJECTIVE: To determine whether the initial Glasgow Coma Scale (GCS) score is predictive of intubation difficulty in out-of-hospital airway management of poisoned patients. METHODS: A prospective, observational study was performed in a toxicological intensive care unit of a university hospital and in a physician-based out-of-hospital care system. Subjects included consecutive poisoned patients intubated during their airway management by out-of-hospital medical teams before hospitalization. The intubating operator (emergency physician or nurse anesthetist) completed a 1-page checklist concerning the clinical parameters and circumstances (nature of sedation and difficulty) of endotracheal intubation upon hospital arrival. RESULTS: Forms were completed for all 394 consecutive out-of-hospital intubations. The patients ranged from 15 to 95 years of age (median age 38 years). Most (96%) of the intubations were via the oral route. Intubation difficulty was related to GCS values. Intubation difficulty was seen more often in patients with 7 < or = GCS < or = 9 (36%) than in patients with GCS < 7 (15%) or > 9 (10%). Not surprisingly, perceived intubation difficulty was least for those patients undergoing rapid-sequence intubation rather than administration of sedation alone. CONCLUSION: Maximum difficulty of intubation is encountered in poisoned patients with 7 < or = GCS < or = 9. Intubation of such patients appears to be facilitated by appropriate sedation and/or neuromuscular blockade.

Adolescent↗
PubMed1998

A survey of sedation protocols used for emergency endotracheal intubation in poisoned patients in the French prehospital medical system.

The purpose of this study was to evaluate prehospital sedation protocols used by several French mobile intensive care units for difficult intubations in poisoned patients. This prospective, descriptive study was performed within the toxicological intensive care unit in a university hospital. Consecutive poisoned patients intubated during their airway management by prehospital medical teams were included. Intubating physicians completed a one-page checklist concerning the circumstances of endotracheal intubation. Intubation difficulty was significantly related to the nature of sedation protocols. The use of etomidate alone as an intubation sedative agent was associated with significantly poorer intubating conditions (47.2% difficult) than other sedative agents or neuromuscular blockade). Neuromuscular blockade with sedation in our series was associated with the lowest incidence of difficult intubations in poisoned patients. Sedation alone for intubation appears to be inadequate to achieve good intubating conditions in a significant proportion of patients.

Adult↗
PubMed1997

[Acidosis and hyperlactatemia in acute sodium valproate poisoning].

OBJECTIVES: We searched for signs of metabolic acidosis and associated hyperlactatemia in case of sodium valproate overdose. PATIENTS AND METHODS: A retrospective study was conducted in the toxicology intensive care unit at the Fernand Widal hospital from 1990 to 1995. Patients retained for study had sodium valproate levels above the therapeutic range (> 600 mumol/l). Data collected included past history, intubation for mechanical ventilation, administration of catecholamines and infusion of bicarbonate or sodium lactate, and blood pressure. Laboratory tests included serum sodium valproate, pH, PCO2, bicarbonate, anion balance and lactate. RESULTS: The study included 22 consecutive patients. None had a history of liver disease. Thirteen patients were intubated before admission to intensive care. Two received catecholamines. None of the patients received bicarbonate or sodium lactate. Mean blood pressure was 118 +/- 16 mmHg, mean serum sodium valproate was 2668 +/- 2437 mumol/l, mean pH was 7.41 +/- 0.08, mean PO2 35.6 +/- 8.0, mean anion imbalance 23.2 +/- 6.0 mmol/l and mean lactate 5.0 +/- 2.1 mmol/l. There was a significant correlation between lactase and pH (p < 0.003). CONCLUSION: We found metabolic acidosis with major anion imbalance and high lactate levels in patients with acute sodium valproate intoxication. Hyperlactatemia could be due to the direct effect of sodium valproate or to an unknown mechanism.

Acidosis↗
PubMed1997

Benefit of active compression-decompression cardiopulmonary resuscitation as a prehospital advanced cardiac life support. A randomized multicenter study.

BACKGROUND: We compared short-term prognosis of active compression-decompression (ACD) and standard (STD) cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrests. METHODS AND RESULTS: We randomized advanced cardiac life support (ACLS) with ACD ACLS CPR on odd days and STD ACLS CPR on even days. We measured the rates of return of spontaneous circulation (ROSC), survival at 1 hour (H1), at 24 hours (H24), and at 1 month (D30): hospital discharge (HD); neurological outcome; and complications. Mean times from collapse to basic cardiac life support CPR was 9 minutes and from collapse to ACLS CPR was 21 minutes. Compared with the STD ACLS patients (n = 258), ACD ACLS patients (n = 254) had higher survival rates (ROSC, 44.9% versus 29.8%, P = .0004; H1, 36.6% versus 24.8%, P = .003; H24, 26% versus 13.6%, P = .002; HD without neurological impairment, 5.5% versus 1.9%, P = .03) and a trend for improvement in neurological outcome at D30 (Glasgow-Pittsburgh Outcome Categories = 1.6 +/- 0.8 versus 2.3 +/- 1.1. P = .09). Sternal dislodgements (2.9% versus 0.4%, P = .03) and hemoptysis (5.4% versus 1.3%, P = .01) were more frequent in the ACD ACLS group. CONCLUSIONS: Despite long time intervals, ACD significantly improved short-term survival rates in out-of-hospital cardiac arrests compared with STD CPR.

Adult↗
PubMed1997

Optimization of glottic exposure during intubation of a patient lying supine on the ground.

Two methods of endotracheal intubation of patients lying on the ground were compared for ease and speed of intubation and minimization of complications in a crossover study of prehospital-oriented emergency physicians. Intubation of a mannequin was attempted by the physicians in either a left lateral decubitus (LLD) position or a kneeling (K) position, followed by the alternate position. The LLD position afforded more rapid intubation, better glottic visualization, and less dental trauma. Eighty-seven percent of physicians completely visualized the glottis in the LLD position, versus 33% of the K position group. Intubation times were 10.5 versus 14.6 seconds in the LLD and K positions, respectively (P < .001). The LLD position is a more effective position (in a mannequin model) than the K position for intubation of patients found lying on the ground, a frequent situation in prehospital care.

Cross-Over Studies↗