16/05/2019
PST hémostatiques: Equivalents mais bases scientifiques pauvres
Systematic review of prehospital haemostatic dressings.
INTRODUCTION:
Haemorrhage is one of the leading causes of battlefield and prehospital death. Haemostatic dressings are an effective method of limiting the extent of bleeding and are used by military forces extensively. A systematic review was conducted with the aim of collating the evidence on current haemostatic products and to assess whether one product was more effective than others.
METHODS:
A systematic search and assessment of the literature was conducted using 13 health research databases including MEDLINE and CINAHL, and a grey literature search. Two assessors independently screened the studies for eligibility and quality. English language studies using current-generation haemostatic dressings were included. Surgical studies, studies that did not include survival, initial haemostasis or rebleeding and those investigating products without prehospital potential were excluded.
RESULTS:
232 studies were initially found and, after applying exclusion criteria, 42 were included in the review. These studies included 31 animal studies and 11 clinical studies. The outcomes assessed were subject survival, initial haemostasis and rebleeding. A number of products were shown to be effective in stopping haemorrhage, with Celox, QuikClot Combat Gauze and HemCon being the most commonly used, and with no demonstrable difference in effectiveness.
CONCLUSIONS:
There was a lack of high-quality clinical evidence with the majority of studies being conducted using a swine haemorrhage model. Iterations of three haemostatic dressings, Celox, HemCon and QuikClot, dominated the studies, probably because of their use by international military forces and all were shown to be effective in the arrest of haemorrhage.
12/05/2019
Réchauffeur: M Warmer, the best ?
Comparison of portable blood-warming devices under simulated pre-hospital conditions: a randomised in-vitro blood circuit study.
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Lire aussi cet article qui met en avant la performance du Qiflow warmer
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Pre-hospital transfusion of blood products is a vital component of many advanced pre-hospital systems. Portable fluid warmers may be utilised to help prevent hypothermia, but the limits defined by manufacturers often do not reflect their clinical use. The primary aim of this randomised in-vitro study was to assess the warming performance of four portable blood warming devices (Thermal Angel, Hypotherm X LG, °M Warmer, Buddy Lite) against control at different clinically-relevant flow rates. The secondary aim was to assess haemolysis rates between devices at different flow rates. We assessed each of the four devices and the control, at flow rates of 50 ml.min-1 , 100 ml.min-1 and 200 ml.min-1 , using a controlled perfusion circuit with multisite temperature monitoring. Free haemoglobin concentration, a marker of haemolysis, was measured at multiple points during each initial study run with spectrophotometry. At all flow rates, the four devices provided superior warming performance compared with the control (p < 0.001). Only the °M Warmer provided a substantial change in temperature at all flow rates (mean (95%CI) temperature change of 21.1 (19.8-22.4) °C, 20.4 (19.1-21.8) °C and 19.4 (17.7-21.1) °C at 50 ml.min-1 , 100 ml.min-1 and 200 ml.min-1 , respectively).
There was no association between warming and haemolysis with any device (p = 0.949) or flow rate (p = 0.169). Practical issues, which may be relevant to clinical use, also emerged during testing. Our results suggest that there were significant differences in the performance of portable blood warming devices used at flow rates encountered in clinical practice.
02/05/2019
Tourniquet gonflable: Un nouveau venu
Rescue Bandage TQ Inflatable Tourniquet
Un garrot développé dans le cadre de la campagne STOP THE BLEED.
07/04/2019
Un drone pour le blessé de guerre ? Plutôt plusieurs
Clic sur l'image pour accéder au document SOFINS 2019
| Tags : drone
20/11/2018
The MARCH belt
De quoi avoir sur soi et sans ouvrir son sac pour réaliser le MARCH
CRO MARCH Belt (CROMEDICALGEAR.COM)
19/10/2018
Intubation dans le noir: Plutôt Poncho que JVN
OBJECTIVE:
Strict blackout discipline is extremely important for all military units. To be able to effectively determine wound characteristics and perform the necessary interventions at nighttime, vision and light restrictions can be mitigated through the use of tactical night vision goggles (NVGs). The lamp of the classical laryngoscope (CL) can be seen with the naked eye; infrared light, on the other hand, cannot be perceived without the use of NVGs. The aim of the study is to evaluate the safety of endotracheal intubation (ETI) procedures in the darkunder tactically safe conditions with modified laryngoscope (ML) model.
METHODS:
We developed an ML model by changing the standard lamp on a CL with an infrared light-emitting diode lamp to obtain a tool which can be used to perform ETI under night conditions in combination with NVGs. We first evaluated the safety of ETI procedures in prehospital conditions under darkness by using both the CL and the ML for the study, and then researched the procedures and methods by which ETI procedure could be performed in the dark under tactically safe conditions. In addition, to better ensure light discipline in the field of combat, we also researched the benefits, from a light discipline standpoint, of using the poncho liner (PL) and of taking advantage of the oropharyngeal region during ETIs performed by opening the laryngoscope blades directly in the mouth and using a cover. During the ETI procedures performed on the field, two experienced combatant staff simulated the enemy by determining whether the light from the two different types of laryngoscope could be seen at 100-m intervals up to 1,500 m.
RESULTS:
In all scenarios, performing observations with an NVG was more advantageous for the enemy than with the naked eye. The best measure that can be taken against this threat by the paramedic is to ensure tactical safety by having an ML and by opening the ML inside the mouth with the aid of a PL. The findings of the study are likely to shed light on the tactical safety of ETI performed with NVGs under darkness.
CONCLUSION:
Considering this finding, we still strongly recommend that it would be relatively safer to open the ML blade inside the mouth and to perform the procedures under a PL. In chaotic environments where it might become necessary to provide civilian health services for humanitarian aid purposes (Red Crescent, Red Cross, etc.) without NVGs, we believe that it would be relatively safer to open the CL blade inside the mouth and to perform the procedures under a PL.
17/01/2018
Histoire de mandrin
Il n'est parfois pas simple de bien maintenir un mandrin d'intubation dans le bon axe. Vous sont proposé en 3,4 et 5 plusieurs manières de s'en sortir.
15/01/2018
Une sonde de Foley dans le thorax
Balloon Foley catheter compression as a treatment for intercostal vessel bleeding
Chao BF et Al. Injury. 2011 Sep;42(9):958-9.
Avoir DEUX FOLEY avec soi, et ce n'est pas pour faire un sondage urinaire mais pour réaliser un tamponnement nasal, intercostale, d'une plaie cervicale ou tout simpment pour draîner un thorax
21/07/2017
SOFT-Tourniquet: Du nouveau
Tactical Médical Solutions qui est le fabricant du SOFT-Tourniquet, garrot en dotation dans l'armée française, propose une nouvelle version de son garrot Wide. Sa nouvelle boucle est d'emploi bien plus aisé que la précédente et positionne ce garrot parmi les tous meilleurs(CAT, SOFT-T, TK4,...)
Clic sur l'image pour accéder au site. Le distributeur en France.
| Tags : tourniquet
21/09/2016
Trauma Jonctionnel: Quels dispositifs appliquables ?
12/01/2016
Echographe ultraportable: Du choix !
L'embarras du choix mais l'expertise doit passer avant
| Tags : échographie
18/12/2015
Ejector ventilator: Quésaco ?
Ventrain: an ejector ventilator for emergency use
Hamaekers AE et Al. Br J Anaesth. 2012 Jun;108(6):1017-21
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La ventilation sur cathéter de coniotomie n'est pas chose aisée du fait de l'importance des résistances à l'écoulement des gaz dans un cathéter de petit diamètre. On considère que sans dispositif d'injection de type manujet, il faut un cathéter d'au moins 4 mm pour assurer un minimum acceptable. Certains ont proposé d'avoir recours à une expiration active. Il s'agissait de dispositifs expérimentaux. Ce n'est pas le cas du Ventrain qui apparaît être un produit abouti. A suivre
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The Use of Ventrain from Ventinova Medical BV on Vimeo.
| Tags : coniotomie
23/11/2015
Médecine militaire et civile
Apports de la médecine de l’avant militaire en situation préhospitalière civile
Derkenne C. et Al. Ann. Fr. Med. Urgence (2015) 5:245-251
L’évolution récente des matériels issus de la médecine de guerre pourrait profiter à la médecine préhospitalièrecivile. Des dispositifs comme les garrots ou les pansements hémostatiques sont encore très peu diffusés en pratique civile, malgré des recommandations fortes et assez anciennes de sociétés savantes civiles. Les dispositifs de lutte contre l’hypothermie en préhospitalier sont, en pratique civile, limités, là où les praticiens militaires disposent de couvertures perfectionnées et beaucoup plus efficaces. Enfin, un modèle de kit de drain thoracique, ergonomique, léger et autorisant l’autotransfusion nous paraît pouvoir avantageusement remplacer les différents moyens disponibles en Smur. Selon des données scientifiques issues essentiellement de la médecine militaire, l’utilisation de ces matériels en médecine préhospitalière civile pourrait être particulièrement utile lors de la prise en charge de traumatisés sévères.
| Tags : matériel
04/11/2015
Refroidir sans eau au Mali: Possible !
Couverture Polarskin Pervivolabs
La précocité du refroidissement d'une hyperthermie est fondamentale. Problème comment faire quand on n'a pas d'eau. Cette situation est particulièrement fréquente au sahel. Des produits innovants comme ceux de la gamme Polarskin de la société Pervivolabs, qui dispose d'un distributeur en France, pourraient apporter une solution. Il faut néanmoins que ces couvertures soient transportées en glacière. Mais ceci est plus facile à trouver que de l'eau.
| Tags : hyperthermie
11/10/2015
Bande de compression
Battle Wrap et Battle Bandage
Pouvoir réaliser un pansement compressif est essentiel notamment lors de la prise en charge de trauma jonctionnels. La réalisation et la tenue dans le temps des pansements peut s'avérer complexe. Le produit proposé par cette société semble intéressant car il permet de pouvoir disposer sous un très faible volume/poids d'un équipement permettant un bandage compressif large.
| Tags : pansement
23/07/2015
BIG et FAST: Evolutions récentes
Le BIG et Le FAST1 sont les dispositifs historiques d'accès intraosseux par impaction. Ils ont évolué. La nouvelle version du BIG est le NIO, celle du FAST1 est le FASTX. On rappelle que le BIG est en o dotation dans l'armée français et que différence fondamentale le BIG ne s'applique pas en sternal, alors qu'il s'agit du site de pose exclusif du FAST. On peut penser que ce dernier est moins polyvalent qu'un système permettant un abord huméral, tibial ou iliaque (lire la fiche mémento).
| Tags : intraosseux
03/03/2015
Tapis de sol: Pour immobiliser
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.
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.
| Tags : tourniquet, garrot, hémorragie
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.

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.
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).
