Biomedical subjects

P Ocquidant

Publications and source records attributed to P Ocquidant.

6 recordsLinked to original sources

PubMed2003

[Tracheo-oesophageal fistula. A rare complication of percutaneous tracheostomy].

Percutaneous tracheostomy is more and more used in the intensive care units. However, it's not devoid of risks. We report the case of a patient who developed a tracheo-esophageal fistula discovered after removal of the cannula 23 days after tracheotomy. During the procedure, difficulties occurred during the insertion of the cannula. This case report reminds the importance of a peroperative continuous endoscopic guidance and the need of a rigorous learning.

Catheterization↗

PubMed1999

[Severe hemorrhage from rupture of an intra-oral arteriovenous malformation].

We report the case of a 47-year-old woman with a sudden, spontaneous exsanguinating haemorrhage from an arteriovenous malformation of the mandible. The diagnosis was obtained with a contrast enhanced CT-scan and a digital subtraction angiography. As arterial embolisation was not available the lesion was treated surgically.

Angiography↗

PubMed1999

[Severe head injuries: effects of pre-hospital mechanical ventilation on capnia].

OBJECTIVE: To assess the effect on PaCO2 of mechanical ventilation during prehospital management of severely head-injured patients. STUDY DESIGN: Retrospective observational study. PATIENTS: Severely head-injured patients with Glasgow coma score < or = 8. All patients were sedated, with the trachea intubated and the lungs mechanically ventilated. METHODS: According to the capnia measured at the admission in the neurosurgical intensive therapy unit they were allocated into one of the following three groups: hypocapnia group (PaCO2 < 30 mmHg), recommended capnia group (PaCO2 = 30-38 mmHg) and hypercapnia group (PaCO2 > 38 mmHg). RESULTS: Out of the 42 patients with similarly severe head injuries, 19% were included in the recommended capnia group (PaCO2: 34 +/- 2 mmHg), 38% in the hypocapnia group (PaCO2: 23 +/- 3 mmHg) and 43% in the hypercapnia group (PaCO2: 47 +/- 7 mmHg). In all except three, PaO2 was above 95 mmHg. The settings of ventilatory parameters on the ventilators were similar. CONCLUSION: In 81% of patients, mechanical ventilation was inadequate as far as PaCO2 levels are concerned. Major hypocapnia and hypercapnia carry a potential risk for cerebral ischaemic. Therefore it is recommended to monitor PETCO2 during prehospital transport in medical ambulances and to determine arterial blood gases at arrival of severely head-injured patients in the admission unit for emergencies.

Adolescent↗

PubMed1995

[Interscalenic block: accidental catheterization of the epidural space].

A case is reported of inadvertent insertion of a brachial plexus catheter into the cervical epidural space, at the sitting of an interscalene block for postoperative analgesia, during the recovery from general anaesthesia after surgical repair of a rupture of the rotator cuff of the shoulder. No features of cervical epidural anaesthesia were seen after the first injection of local anaesthetic, as it was made through the catheter insertion cannula. Once inserted, the catheter position was checked prior to the second injection of local anaesthetic. The X-ray obtained after catheter opacification showed the penetration of contrast medium into the epidural space. In our case, two out of the three means of prevention of this complication were not possible: a) sitting of the interscalene block before induction of anaesthesia, as the insertion conditions of the catheter are better in a conscious, sitting patient; b) adequate cannula orientation (namely medial, dorsal and slightly caudal); c) routine X-ray control of the catheter position before the first injection, associated with careful clinical monitoring for 30 min after each local anaesthetic injection.

Brachial Plexus↗

PubMed1994

[Multiple trauma in the elderly].

Morbidity and mortality following multiple trauma are high in elderly patients. Head trauma has a particularly poor prognosis. However intensive care may improve the survival rate and the quality of life in survivors, allowing those to return home.

Age Factors↗

PubMed1993

[Fatal streptococcus A shock after thoracic surgery].

A 23-year-old man with relapsing pneumothorax underwent surgical removal of left apical lung bullae and pleural rubbing down. Forty-eight hours later, he suddenly developed a state of shock together with tachypnoea, oliguria, and a scarlet-like erythema of the face and trunk. Haemodynamic and other investigations led to the diagnosis of septic shock, although no portal of entry could be found. Despite antibiotics (vancomycin, gentamycin and pefloxacine) and symptomatic treatment, the patient's condition continued to worsen. He had a fever (40 degrees C) with abdominal tenderness. Exploratory laparotomy failed to disclose a septic foyer. On aspiration of the left thoracic cavity, a large pyothorax was found and 600 mls of pus were drained. Gram-positive cocci were found on staining and pefloxacine was replaced by mezlocillin. Nevertheless, the patient died within 24 h. Blood and pus cultures confirmed that the infection was due to a pyrogenic penicillin-sensitive group A Streptococcus. Similar cases have been described recently. Group A Streptococcus is suspected to cause severe infections with multiple organ failure, termed "toxic shock-like syndrome". The clinical similarity between the streptococcal and staphylococcal shocks calls for a precise bacteriological diagnosis, and treatment with antibiotics active on both germs.

Adult↗