[Fatal streptococcus B meningitis at the end of pregnancy].
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Adult↗
Biomedical subjects
N Defrance
Publications and source records attributed to N Defrance.
[Early management of severe brain injuries].
Severe head injury (Glasgow Coma Score less than or equal to 7) is associated with high mortality and morbidity which can be improved by early energetic therapy. Such patients must be picked up by prehospital/EMS service with three aims: controlling ventilation, controlling haemodynamics, avoiding any increased intracranial pressure. After initial neurological assessment, management involves endotracheal intubation, mechanical ventilation following benzodiazepine sedation, early compensation of hypovolemia avoiding any overloading, analgesia for painful injuries; according to the clinical status other pharmacological agents can be used. At admission to emergency unit, intensive care must be continued while X-rays and CT-scan are achieved. Imperative indications of transport to neuro-intensive care unit are discussed for hospitals without a neuro-surgeon.
Brain Injuries↗
[Technical constraints in rapid vascular fluid replacement].
Rapid fluid infusion remains the cornerstone for therapy of hypovolaemic shock. The principal limitations of flow rate are governed by the four variables of Poiseuille's law: tube internal diameter and length, viscosity of the fluid passing through the tube, and the pressure gradient between the two ends of the tube. Conventional transfusion systems, with wide bore tubing (up to 5.0 mm internal diameter), large bore cannulas (8.5 French introducer catheters), high pressure (up to 300 mmHg) and diluted blood, can result in a maximum flow rate of about 1,000 ml.min-1 (for crystalloid solutions). Specific apparatus for rapid infusion can increase this to 1,500 ml.min-1 (Rapid Infusion System, Haemonetics). Dry-heat warming devices and microfiltration, to remove microaggregates and prevent non haemolytic febrile transfusion reactions, seem necessary when carrying out rapid transfusions. However, the use of microaggregate filters could be avoided by the routine production of leukocyte-poor red blood cell concentrates.
Blood Transfusion↗