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03/03/2015

Tapis de sol: Pour immobiliser

 

ImmobilisationTapisSol.jpg

Clic sur l'image pour accéder à la source

| Tags : immobilisation

13/01/2015

Attentats: Importance du garrot

The Initial Response to the Boston Marathon Bombing. Lessons Learned to Prepare for the Next Disaster 

Gates JD et AL. Ann Surg. 2014 Dec;260(6):960-6

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Le concept du garrot tactique est familier aux équipes militaires. L'expérience rapportée montre que ce concept doit également le devenir dans le monde de la médecine préhospitalière. 26 soit près de 10% blessés pris en charge ont fait l'objet d'une pose de garrot. Ainsi en cas d'attentat la pose précoce d'un garrot en cas d'hémorragie des membres est elle une mesure fondamentale de mise en condition de survie.

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OBJECTIVE:

We discuss the strengths of the medical response to the Boston Marathon bombings that led to the excellent outcomes. Potential shortcomings were recognized, and lessons learned will provide a foundation for further improvements applicable to all institutions.

BACKGROUND:

Multiple casualty incidents from natural or man-made incidents remain a constant global threat. Adequate preparation and the appropriate alignment of resources with immediate needs remain the key to optimal outcomes.

METHODS:

A collaborative effort among Boston's trauma centers (2 level I adult, 3 combined level I adult/pediatric, 1 freestanding level I pediatric) examined the details and outcomes of the initial response. Each center entered its respective data into a central database (REDCap), and the data were analyzed to determine various prehospital and early in-hospital clinical and logistical parameters that collectively define the citywide medical response to the terrorist attack.

RESULTS:

A total of 281 people were injured, and 127 patients received care at the participating trauma centers on that day. There were 3 (1%) immediate fatalities at the scene and no in-hospital mortality. A majority of the patients admitted (66.6%) suffered lower extremity soft tissue and bony injuries, and 31 had evidence for exsanguinating hemorrhage, with field tourniquets in place in 26 patients. Of the 75 patients admitted, 54 underwent urgent surgical intervention and 12 (22%) underwent amputation of a lower extremity.

Tourniquet Boston.jpg

CONCLUSIONS:

Adequate preparation, rapid logistical response, short transport times, immediate access to operating rooms, methodical multidisciplinary care delivery, and good fortune contributed to excellent outcomes.

13/12/2014

Quikclot: Un bon choix, mais les autres aussi

Comparison of novel hemostatic dressings with QuikClot combat gauze in a standardized swine model of uncontrolled hemorrhage.

Rall JM et AL. J Trauma Acute Care Surg. 2013 Aug;75(2 Suppl 2):S150-6 

L'emploi des pansements hémostatiques en médecine de l'avant est devenue une pratique courante, même si cette dernière s'appuie sur relativement peu d'arguments avérés. Leur efficacité repose sur leur application au contact de la lésion qui saigne et une compression initiale. Hors ces deux critères de performance sont pas toujours remplis en condition de combat. C'est ce qui explique que certains soient relativement critiques par rapport à leur intérêt réel en condition de combat et on insiste beaucoup actuellement sur la notion de pansement compressif et de packing de plaie. Il n'en demeure pas moins indispensable de connaître ce que propose l'industrie en la matière. Le document proposé fait le point sur le différents produits utilisables. Il utilise pour cela un modèle expérimental de plaie artérielle. Sont comparés trois produits le Quikclot, le Celox et le Chitogauze. 5 versions au total sont analysées car le Quikclot et le Celox sont proposés en deux versions qui  diffèrent par leur masse.

PstHemoS1.jpeg.jpg

PstHemoS3.jpeg.jpg

Très globalement plus la masse de produit est grande et plus l'efficacité est au rendez vous (Le Quikclot XL et le Celox, masse de 50 g de pansement) . Parmi les présentations qui proposent une masse de pansement de l'ordre de 20g l'Hemcon Chitogauze apparaît être immédiatement le plus efficace malheureusement  est observé un pourcentage de resaignement élevé. Finalement de ce document on peut retenir que l'Hemcon Chitogauze, le CeloxTrauma gauze et le Quikclot Gauze ont des performances similaires. On remarque que pour le Quikclot Gauze la survie à 150 min est la plus élevée pour les pansements de 20 g, même si ceci n'est pas significatif au plan statistique. Ce dernier reste donc un très bon choix. Il est en dotation dans l'armée française . 

On rappelle que ce dernier existe en deux version la version rolled et la version Z folded qui est plus particulièrement mise en avant par le fabricant pour les applications militaires

(vidéo de mise en oeuvre)

 

 

| Tags : packing, pansement

01/11/2014

N'oublions pas: Comprimer est essentiel

Laboratory assessment of out-of-hospital interventions to control junctional bleeding from the groin in a manikin model l.

Kragh JF et Al Am J Emerg Med. 2013 Aug;31(8):1276-8 

Junctional body regions between the trunk and its appendages, such as the groin, are too proximal for a regular limb tourniquet to fit [1,2]. Not since 1993’s Black Hawk Down has junctional hemorrhage control become such a hot topic in military casualty care [1–7]. In February 2013, the US military’s Task Force Medical Afghanistan requested a fill of a gap in junctional hemorrhage control as an urgent operational need, meaning that junctional hemorrhage control devices should be considered urgently to fill a gap in medical care in war. A small but growing body of evidence indicates that hemorrhage control can be attained out-of-hospital with mechanical compression, using such interventions as medical devices, on a pressure point proximal to a bleeding wound [3–9]. To evaluate laboratory use of junctional hemorrhage control interventions, we gathered data on stopping groin bleeding in a manikin model to understand the plausibility of such interventions for future human subject research.

Under an approved protocol, we tested efficacy of interventions in a manikin designed to train medics in out-of-hospital hemorrhage control (Combat Ready Clamp [CRoC] Trainer Manikin, Operative Experience, Inc, North East, MD). We filled the blood reservoir with 4 liters of water; we refilled the reservoir after 5 iterations or 1.5 liters of lost fluid, whichever came first. The manikin had a right-groin gunshot wound through the proximal thigh where the common femoral artery flow was controllable by skin compression over it at the level of the inguinal fold. There was 3 cm between the pressure point where compression was applied and the proximal extent of the wound. Interventions were timed, blood loss was measured, and efficacy was noted. Efficacy was operationally defined as visually stopped flow into the wound from the vessel lumen. Pearls and pitfalls of intervention use were recorded.

Interventions to control hemorrhage included medical device use, manual or digital compression, and improvised use of a rock-like kettlebell (to simulate a rock used in care on the battlefield in a case recorded in the Department of Defense Trauma Registry in 2012). Interventions included digital (finger) compression, manual compression (heel of the hand), knee compression, compression by a 50lb kettlebell (Hampton Fitness Products, Ventura, CA), and medical device use (Combat Ready Clamp, CRoC, Combat Medical Systems, Fayetteville, NC; SAM Junctional Tourniquet, SAM, SAM Medical Products, Portland, OR; Junctional Emergency Treatment Tool, JETT, North American Rescue Products, Greer, SC; Abdominal Aortic Tourniquet, AAT, Compression Works, Hoover, AL). The first device assessed was the CRoC which, of the devices studied, was cleared first by the US Food and Drug Administration on August 11, 2010. The first setting of the evaluation (which was for the CRoC) was in a simulation center as previously reported with three to five people, and the other setting of the evaluation was on a table with one to three people [5]. The data from that initial setting is included here for comparison of time to stop bleeding, blood loss volume, and device efficacy [5]. Since the blood loss rate was non-linear (as it is in real situations for casualties because bleeding is brisker initially rather than later), we did not refill the bladder after each iteration. The manikin was not designed to differentiate between performance of devices, so we only compared results to acceptable benchmarks. The benchmark for time to stop bleeding was 300 seconds (s), and the benchmark for blood loss was a normal adult male blood volume, 5 L. Hemorrhage was controlled with 100% efficacy in the manikin model for each intervention. The times to stop bleeding and volumes of blood lost were acceptable for all devices and iterations (Figs. 1 and 2; Tables 1 and 2). Advantages and disadvantages were learned with experience in the use of each intervention (Table 3). Traits of interventions varied through wide ranges (Table 4).

kragh 3.jpgkragh 4.jpg

 

[1] Tai NR, Dickson EJ. Military junctional trauma. J Roy Army Med Corps 2009;155(4): 285–92.
[2] Ficke JR, Obremskey WT, Gaines RJ, et al. Reprioritization of research for combat casualty care. J Am Acad Orthop Surg 2012;20:S99–S102.
[3] Tovmassian RV, Kragh Jr JF, Dubick MA, et al. Combat Ready Clamp medic technique. J Spec Oper Med 2012;12(4):70–8.
[4] Kragh Jr JF, Murphy C, Dubick MA, et al. New tourniquet device concepts for battlefield hemorrhage control. US Army Med Dept J 2011:38–48.
[5] Mann-Salinas EA, Kragh Jr JF, Dubick MA, Baer DG, Blackbourne LH. Assessment of users to control simulated junctional hemorrhage with the Combat Ready Clamp (CRoC™). Int J Burns Trauma 2013;3(1):49–54 [Epub ahead of print].
[6] Bowden M. Black hawk down: a story of modern War. New York: Penguin Group; 2000
[7] Pre-Hospital Trauma Care Assessment Team. Saving lives on the battlefield: a Joint Trauma System of pre-hospital trauma care in Combined Joint Operating Area-Afghanistan, final report. US Central Command; 2013.
[8] Gerhardt RT, De Lorenzo RA, Oliver J, et al. Out-of-hospital combat casualty care in the current war in Iraq. Ann Emerg Med 2009;53(2):169–74.
[9] Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma Acute Care Surg Dec 2012;73(6 Suppl 5):S431–7.

27/10/2014

Perfuser + vite: Pas n'importe comment !

Novel rapid infusion device for patients in emergency situations

Kapoor DJ et Al. Scand J Trauma Resusc Emerg Med. 2011 Jun 10;19:35

Il peut être nécessaire d'accélérer le débit d'une perfusion. Pour cela il peut être fait appel à une manchette à pression, une tubulure de type 'blood pump", un système "robinet 3 voies ", plus rarement un système à compression par lame voire une pompe électrique.

Le document présenté fait appel à l'injection d'air dans le corps du soluté utilisé. La sécurité de cette manière de faire interpelle quelque peu. En effet les auteurs estiment que le filtre 15µ présent dans la tubulure a un effet barrière anti air suffisant pour éviter tout risque d'embolie gazeuse. 

Rapidnfusion.jpgCe type de pratique est associé à une prise de risque du fait du concept même de la méthode, des conditions d'hygiène non respectées et des conditions de surveillance non optimales en conditions extrême.

 

03/09/2014

Ne comprimez pas les yeux

The use of rigid eye shields (Fox shields) at the point of injury for ocular trauma in Afghanistan

Mazolli RA et Al. J Trauma Acute Care Surg. 2014;77: S156-S162 

BACKGROUND:
Unlike hemorrhagic injuries in which direct pressure is indicated, any pressure placed on the eye after penetrating trauma can significantly worsen the injury by expulsing intraocular contents. The accepted first response measure for obvious or suspected penetrating ocular injury is placement of a rigid shield that vaults the eye so as to prevent accidental iatrogenic aggravation during transport to the ophthalmologist. Patching and placing intervening gauze between the shield and the eye are both contraindicated.
ocularTrauma.png
Anecdotally, compliance with these recommendations is poor in the military and civilian communities alike; however, published studies documenting compliance are uniformly lacking. This study was undertaken to provide such an evaluation.

 METHODS:

In this retrospective observational study, the Department of Defense Trauma Registry was reviewed to identify eye injuries in Afghanistan from 2010 to 2012 and to examine compliance with eye shield recommendations. One hundred fifty-seven records of eye casualties were identified and categorized according to diagnostic codes, noting use of a shield. A subset of 30 records was further analyzed for compliance with other core treatment measures specified by the operant Clinical Practice Guideline. Because comparative studies do not exist, simple statistical analysis was performed.

 RESULTS:

Overall, 39% of eye injuries received a shield at the point of injury (61% failure), ranging from 0% to 50% between diagnostic subgroups. Subset analysis revealed that only 4.2% of injuries were successfully mitigated at the point of injury (95.8% failure).

 CONCLUSION:

In one of the few studies documenting the use of eye shields after ocular trauma, anecdotal reports of poor, inadequate, or incorrect compliance with basic recommendations were substantiated. Several factors may account for these findings. Corrective efforts should include enhanced educational emphasis and increased shield availability.

 

 

 

14/12/2013

La trousse de base: Exemple

Elle doit rester SIMPLE, standardisée au sein de l'équipe, permettre l'application du SAFE MARCHE RYAN. Résistez à la tentation d'y introduire du gadget.

Un exemple: 

trousse

Ne sous estimez pas l'importance de disposer de bandages et d'écharpes en quantité suffisante.

| Tags : trousse

Accélerer une perfusion: Comment ?

 

Blood pump.jpg

Clic sur l'image pour accéder au document

Autotransfusion d'hémothorax; Avec quoi ?

Pas simple en l'absence de matériel dédié. Il s'agit d'une technique qu'il faut avoir anticipé. Une affaire de raccords. Le lien qui suit vous propose une méthode.

Kit Autotransfusion.pdf

22/09/2013

Pansement hémostatique:Vraiment utile ?

Watters J et all. J Trauma. 2011;70:1413–1419

Un travail intéressant qui s'interroge sur le vrai intérêt des pansements hémostatiques. Sans remettre en question ce dernier cet article remet en question le positionnement de ce type de matériel. Dans un travail expérimental sur un modèle animal, un packing de plaie avec de la gaze simple serait plus rapide et tout aussi efficace qu'un packing effectué avec le Combat gauze ou le celox gauze.

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Results: All animals survived to study end. There were no differences in baseline physiologic or coagulation parameters or in dressing success rate (SG: 8/8, CG: 4/8, XG: 6/8) or blood loss between groups (SG: 260 mL, CG: 374 mL, XG: 204 mL; p > 0.3). SG (40 seconds ± 0.9 seconds) packed significantly faster than either the CG (52 ± 2.0) or XG (59 ± 1.9). At 120 minutes, all groups had a significantly shorter time to clot formation compared with baseline (p < 0.01). At 30 minutes, the XG animals had shorter time to clot compared with SG and CG animals (p < 0.05). All histology sections had mild intimal and medial edema. No inflammation, necrosis, or deposition of dressing particles in vessel walls was observed. No histologic or ultrastructural differences were found between the study dressings.

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Sans titre.JPG

"There are reasons that standard woven gauze bandages have existed for millennia. They are lightweight, absorbent, highly conformable, stable in a variety of environmental conditions, and inexpensive. Multiple advanced hemostatic agents have resulted in superior homeostasis, improved outcomes, and likely saved lives compared with SG when applied according to manufacturers’ recommendations for compression time. However, in a care under fire scenario or in a situation of mass casualties, compression times of 2 minutes to 5 minutes are not feasible. During ongoing battle, only lifethreatening injuries should be addressed and often the wounded must self-apply a tourniquet or dressing. An individual rendering self or buddy aid will need to continue to engage in battle as the first priority. Major vascular injuries, which cannot be controlled through application of a tourniquet, must be addressed as quickly as possible before profound bleeding incapacitates the casualty. Similarly, when there are persons with multiple injuries or wounds to treat, dressings must be rapidly placed and effective without prolonged hold times"

Conclusion: Ce qui compte c'est la compression et le packing de plaie

| Tags : pansement

22/06/2013

QMS: Eclairage de l'extrême

Un porduit de cette société équipe les lots de chirurgie vitale

QMS.jpeg

http://www.qms-light.fr/index.php

14/04/2013

Brulure: Une revue des pansements

DIM Brule.jpeg

| Tags : brûlure

02/03/2013

Diamètre de KT: 16 G est un bon compromis

Medication and Volume Delivery by Gravity-Driven Micro-Drip Intravenous Infusion: Potential Variations During “Wide-Open” Flow

Pierce E. et all Anesth Analg 2013;116:614–18


Ce travail porte sur l'intérêt d'administrer une perfusion par pompe plutôt que par gravité. Cependant ces deux figures relativisent l'intérêt de la pose de cathéter de 14g comparé à des cathéters de 16g dont les performances sont somme toute assez proches et qui restent bien plus simples à poser.

TailleKT1.jpeg

TailleKT2.jpeg

 

| Tags : perfusion, matériel

08/11/2012

Coniotomie: Pas le kit PCK

 Emergency cricothyroidotomy performed by inexperienced clinicians--surgical technique versus indicator-guided puncture technique

Emerg Med J. 2012 Jul 27. [Epub ahead of print]

Abstract

Background To improve the ease and safety of cricothyroidotomy especially in the hand of the inexperienced, new instruments have been developed. In this study, we compared a new indicator-guided puncture technique (PCK) with standard surgical technique (ST) regarding success rate, performance time and complications.

Methods Cricothyroidotomy in 30 human cadavers performed by 30 first year anaesthesia residents. The set chosen for use was randomised: PCK-technique (n=15) and ST (n=15). Success rates, insertion times and complications were compared. Traumatic lesions were anatomically confirmed after dissection.

Results The ST-group had a higher success rate (100% vs 67%; p=0.04). There was no difference in time taken to complete the procedure (PCK 82 s. vs ST 95 s.; p=0.89). There was a higher complication rate in the PCK-group (67% vs 13%; p=0.04). Most frequent complication in the PCK-group was injury to the posterior tracheal wall (n=8), penetration to the oesophageal lumen (n=4) and injury to the thyroid and/or cricoid cartilage (n=5). In the ST-group in only 2 cases minor complications were observed (small vessel injury).

Conclusions In this human cadaver study the PCK technique produced more major complications and more failures than the ST. In the hand of the inexperienced operator the standard surgical approach seems to be a safe procedure, which can successfully be performed within an adequate time. The PCK technique cannot be recommended for inexperienced operators.

 

11/03/2012

Drainage Thoracique: Histoire de drain

A portable thoracic closed drainage instrument for hemopneumothorax.J Trauma. 2012;72: 671–675 Tang H; Pan T MD et all.

La pose d'un drain thoracique en préhospitalier s'impose dès lors qu'un pneumothorax n'est pas traité de manière correcte par une thoracostomie au doigt/Exsufflation à l'aiguille ou si l'évacuation du blessé est retardée. Le Front Line Chest Tube est l'équipement préconisé par la procédure du sauvetage au combat. Une alternative de fortune peut être une sonde d'intubation ou une canule de trachétomie. Cet article illustre le travail de réflexion fait pour mettre à disposition un équipement adapté au contexte pré-hopsitalier notamment militaire.  L'emploi de tubes à ballonet est proposé par des auteurs chinois qui ont dévelopé ce nouveau matériel présenté dans le Journal of Trauma

NewChestDrainage.jpg

10/03/2012

Garrot abdominal ?

L'arrêt des hémorragies lors de la prise en charge préhospitalière d'un traumatisme jonctionnel est particulièrement difficile. Nos amis anglais proposent une stratégie de prise en charge. Pendant la guerre du viet-nam les américains avaient recours au pantalon anti-choc dont il existe de nombreuses variantes (1) et dont l'utilité est très discutée en traumatologie civile (2). La mortalité des blessés notamment abdominaux antérieur serait accrue par le recours au PAC (3). Une autre critique est la complexité de sa mise en oeuvre. 

Récemment un dispositif appelé CROC a été présenté. Il permet de réaliser un point de compression en région ilio-inguinale. Bien qu'aucune étude n'ait été publiée, le Comité du TCCC a validé son emploi au combat.

Un autre dispositif de compression abdominale cette fois est présenté. Le tourniquet abdominal aortique (The Abdominal Aortic Tourniquet - AAT™) a pour objectif de réduire le saignement par une compression des structures vasculaires intra-abdominales.

AAT.JPG 

Il existe une documentation expérimentale pour son emploi dont le principe se rapproche du pantalon anti-choc mais dont la simplicité d'emploi semble être sans commune mesure autorisant son emploi en environnement exigu notamment en hélicoptère (?). A suivre

 

23/02/2012

Tourniquet: Le point vu du côté US

The Military Emergency Tourniquet Program's Lessons Learned With Devices and Designs

Kragh et all. MILITARY MEDICINE, 176, 10:1144, 2011

Un travail très intéressant qui porte sur l'analyse de 159 garrots après leur emploi. Les trois plus fréquemment rencontrés sont le CAT, le Delfi EMT et le SOFT-T. 119 était encore utilisables. 28 étaient inefficaces, 52 efficaces et pour le reste étaient non analysable.Le plus efficace est le Delfi EMT suivi par le CAT et le SOFT-T. Il n'a pas été identifié de pose de tourniquet à une main. L'efficacité globale du garrot est en partie rapporté à sa largeur. Une explication retneue d'inefficacité est une tension insuffisante du tourniquet avant la torsion. Des bris de barre de torsion du CAT sont observées. D'autres garrots que l'EMT, le CAT et le SOFT-T sont rencontrés: Le Tourniquet RATCHET LBT et les garrots improvisés dont un exemple est présenté ci-après.

Garrot improvisé.JPG

| Tags : tourniquet, garrot

08/09/2011

Alternative à l'intubation: D'abord la coniotomie chirurgicale !

A meta-analysis of prehospital airway control technique part II: alternative airway devices and cricothyrotomy success rate. Hubble MW et all. Prehosp Emerg Care. 2010 Oct-Dec;14(4):515-30.

Ce document est une métaanalyse récente qui le point dans la littérature sur les alternatives à l'intubation. Elle confirme que la coniotomie chirurgicale est la technique de référence. Elle précise que le tube de King est le dispositiflaryngé le plus pertinent mais qu'il manque globalement de recul sur ces dispositifs. 

 

BACKGROUND:

 

Airway management is a key component of prehospital care for seriously ill and injured patients. Oral endotracheal intubation (OETI) is the definitive airway of choice in most emergency medical services (EMS) systems. However, OETI may not be an approved skill for some clinicians or may prove problematic in certain patients because of anatomic abnormalities, trauma, or inadequate relaxation. In these situations alternative airways are frequently employed. However, the reported success rates for these devices vary widely, and established benchmarks are lacking.

OBJECTIVE:

We sought to determine pooled estimates of the success rates of alternative airway devices (AADs) and needle cricothyrotomy (NCRIC) and surgical cricothyrotomy (SCRIC) placement through a meta-analysis of the literature.We sought to determine pooled estimates of the success rates of alternative airway devices (AADs) and needle cricothyrotomy (NCRIC) and surgical cricothyrotomy (SCRIC) placement through a meta-analysis of the literature.

METHODS:

 

We performed a systematic literature search for all English-language articles reporting success rates for AADs, SCRIC, and NCRIC. Studies of field procedures performed by prehospital personnel from any nation were included. All titles were reviewed independently by two authors using prespecified inclusion criteria. Pooled estimates of success rates for each airway technique were calculated using a random-effects meta-analysis model.

RESULTS:

 

Of 2,005 prehospital airway titles identified, 35 unique studies were retained for analysis of AAD success rates, encompassing a total of 10,172 prehospital patients. The success rates for SCRIC and NCRIC were analyzed across an additional 21 studies totaling 512 patients. The pooled estimates (and 95% confidence intervals [CIs]) for intervention success across all clinicians and patients were as follows: esophageal obturator airway-esophageal gastric tube airway (EOA-EGTA) 92.6% (90.1%-94.5%); pharyngeotracheal lumen airway (PTLA) 82.1% (74.0%-88.0%); esophageal-tracheal Combitube (ETC) 85.4% (77.3%-91.0%); laryngeal mask airway (LMA) 87.4% (79.0%-92.8%); King Laryngeal Tube airway (King LT) 96.5% (71.2%-99.7%); NCRIC 65.8% (42.3%-83.59%); and SCRIC 90.5% (84.8%-94.2%).

CONCLUSIONS:

 

We provide pooled estimates for prehospital AAD, NCRIC, and SCRIC airway interventions. Of the AADs, the King LT demonstrated the highest insertion success rate (96.5%), although this estimate is based on limited data, and data regarding its ventilatory effectiveness are lacking; more data are available for the ETC and LMA. The ETC, LMA, and PTLA all had similar-but lower-success rates (82.1%-87.4%). NCRIC has a low rate of success (65.8%); SCRIC has a much higher success rate (90.5%) and should be considered the preferred percutaneous rescue airway.

02/09/2011

La sonde de foley: Pour l'hémostase

Une sonde de foley est utile non pour réaliser un sondage urinaire sur le terrain mais comme moyen d'hémostase.

 L'emploi de sonde à ballonet pour rélaiser un tamponnement de lésions hémorragiques est une réalité.

 

Ces techniques peuvent trouver un champ d'application au combat notamment pour la prise en charge des traummatisés jonctionnels.

 

Premier exemple: Un saignement d'origine thoracique.

 

Ffoley Thorax.JPG

Balloon Foley catheter compression as a treatment for intercostal vessel bleeding. Chao BF et all Injury, Int. J. Care Injured 42 (2011) 958–959

Autres exemples:

Les plaies sous-clavières

Foley Sous Clav.JPG

 

 

Les plaies cervicales,

neckfoley.jpg

les plaies inguinales,

les épistaxis

| Tags : foley

30/08/2011

Les hémorragies jonctionnelles: Un nouvel outil, le CROC !

L'hémorragie jonctionnelle n'est pas garrotable, n'est pas forcément aisément comprimable directement. Parmi les solutions outre l'exacyl dans l'heure on peut avancer la compression des jonctions.

CROC.jpeg

 

Une recommandation d'emploi du CRoC ( combat ready clamp ) est hautement probable dans la prochaien version du TCCC. Lire ce document:  Hémorragies jonctionnelles.pdf . Regarder une vidéo d'entraînement.

 

l'alternative le femostop ?