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27/05/2012

Extracteur d'O2 SAROS: Révolution ou Evolution ?

http://www.sequal.com/assets/File/9705COMPLETE_B%20web(1)...

Ce type d'extracteur est particulièrement intéressant par sa faible consommation énergétique rendant possible la production de 3 l/min d'un mélange à 93% d'oxygène en autonomie sur batterie à lithium. Cet extracteur est certifié aéronautique US

http://sequal.com/assets/Image/SAROSweb.jpg

| Tags : oxygène

EMD Pro

 

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Le fournisseur des garrots, pansements OLAES Modular Bandage, Quikclot, Foxtrot litter, Tom Manikin de l'armée française

OPS Equipment

 

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ESDT

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Dimatex

 

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H&H Associates

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TAcMed solutions

 

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Chinook Medical

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Narescue

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Morphine: Mieux avec UN PEU de kétamine

Morphine and Ketamine Is Superior to Morphine Alone for Out-of-Hospital Trauma Analgesia: A Randomized Controlled Trial

Jennings et all. Ann Emerg Med. 2012;59:497-503.

Study objective

We assess the efficacy of intravenous ketamine compared with intravenous morphine in reducing pain in adults with significant out-of-hospital traumatic pain.

Methods

This study was an out-of-hospital, prospective, randomized, controlled, open-label study. Patients with trauma and a verbal pain score of greater than 5 after 5 mg intravenous morphine were eligible for enrollment. Patients allocated to the ketamine group received a bolus of 10 or 20 mg, followed by 10 mg every 3 minutes thereafter. Patients allocated to the morphine alone group received 5 mg intravenously every 5 minutes until pain free. Pain scores were measured at baseline and at hospital arrival.

Results

A total of 135 patients were enrolled between December 2007 and July 2010. There were no differences between the groups at baseline. After the initial 5-mg dose of intravenous morphine, patients allocated to ketamine received a mean of 40.6 mg (SD 25 mg) of ketamine. Patients allocated to morphine alone received a mean of 14.4 mg (SD 9.4 mg) of morphine. The mean pain score change was −5.6 (95% confidence interval [CI] −6.2 to −5.0) in the ketamine group compared with −3.2 (95% CI −3.7 to −2.7) in the morphine group. The difference in mean pain score change was −2.4 (95% CI −3.2 to −1.6) points. The intravenous morphine group had 9 of 65 (14%; 95% CI 6% to 25%) adverse effects reported (most commonly nausea [6/65; 9%]) compared with 27 of 70 (39%; 95% CI 27% to 51%) in the ketamine group (most commonly disorientation [8/70; 11%]).

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Conclusion

Intravenous morphine plus ketamine for out-of-hospital adult trauma patients provides analgesia superior to that of intravenous morphine alone but was associated with an increase in the rate of minor adverse effects.

 

 Pour l'analgésie, La kétamine s'emploi à PETITES DOSES car c'est un coantalgique


15/05/2012

Paroi thoracique: En moyenne 3,06 cm chez le japonais

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The mean CWT measured in 192 males and 64 females was 3.06  1.02 cm. The CWT values at 483 sites (94.3%) were less than 5.0 cm. The CWT of females was significantly greater than that of males (3.66 cm vs. 2.85 cm, p < 0.0001), and patients with subcutaneous emphysema had greater CWTs than those without it (4.16 cm vs. 3.01 cm, p < 0.0001).

 

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05/05/2012

Ready heat ou triple couche ?

The effect of active warming in prehospital trauma care during road and air ambulance transportation - a clinical randomized trial.

Lundgren P. et all  Scand J Trauma Resusc Emerg Med. 2011 Oct 21;19:59.

La prévention de l'hypothermie fait appel à des moyens de réchauffement cutanés passifs ( couverture renforcée type Rothco ou la couverture triple couche type blizzard blanket ) ou actifs (couverture ready-heat). Mais comment choisir ?

Le travail présenté ici démontre qu'en présence d'une hypothermie modérée supérieures à 35°C il n'est pas utile d'avoir recours à un moyen actif en terme de limitation de l'hypothermie dès lors que le frisson est conservé. Le seul gain porte sur un confort thermique accru.

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BACKGROUND:

Prevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientific evidence of its effectiveness in a clinical setting is scarce. The objective of this study was to evaluate the effect of additional active warming during road or air ambulance transportation of trauma patients.

METHODS:

Patients were assigned to either passive warming with blankets or passive warming with blankets with the addition of an active warming intervention using a large chemical heat pad applied to the upper torso. Ear canal temperature, subjective sensation of cold discomfort and vital signs were monitored.

RESULTS:

Mean core temperatures increased from 35.1°C (95% CI; 34.7-35.5°C) to 36.0°C (95% CI; 35.7-36.3°C) (p < 0.05) in patients assigned to passive warming only (n = 22) and from 35.6°C (95% CI; 35.2-36.0°C) to 36.4°C (95% CI; 36.1-36.7°C) (p < 0.05) in patients assigned to additional active warming (n = 26) with no significant differences between the groups. Cold discomfort decreased in 2/3 of patients assigned to passive warming only and in all patients assigned to additional active warming, the difference in cold discomfort change being statistically significant (p < 0.05). Patients assigned to additional active warming also presented a statistically significant decrease in heart rate and respiratory frequency (p < 0.05).

CONCLUSIONS:

In mildly hypothermic trauma patients, with preserved shivering capacity, adequate passive warming is an effective treatment to establish a slow rewarming rate and to reduce cold discomfort during prehospital transportation. However, the addition of active warming using a chemical heat pad applied to the torso will significantly improve thermal comfort even further and might also reduce the cold induced stress response.

| Tags : hypothermie

03/05/2012

Actusanté

http://www.defense.gouv.fr/sante/mediatheque/revues/actu-...

 

Procédure du sauvetage au combat

Procédure EVDG

01/05/2012

Field trauma care in the 21st Century

http://www.ramcjournal.com/2008/dec08/oreilly.pdf

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Military medicine in the 21st century: pushing the boundaries of combat casualty care

http://rstb.royalsocietypublishing.org/content/366/1562.toc

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| Tags : traumatologie