Gelures: Une vision actualisée 2014

Frostbite: a practical approach to hospital management

Handford et al. Extreme Physiology & Medicine 2014, 3:7

 

 -------------------------------------------

La prise en charge des gelures évolue notamment par l'apport de la perfusion d'iloprost dans les formes les plus graves et du positionnement en cours de la thrombolyse. Ce document fait une synthèse des données actuelles.

 -------------------------------------------

Frostbite presentation to hospital is relatively infrequent, and the optimal management of the more severely injured patient requires a multidisciplinary integration of specialist care. Clinicians with an interest in wilderness medicine/ freezing cold injury have the awareness of specific potential interventions but may lack the skill or experience to implement the knowledge. The on-call specialist clinician (vascular, general surgery, orthopaedic, plastic surgeon or interventional radiologist), who is likely to receive these patients, may have the skill and knowledge to administer potentially limb-saving intervention but may be unaware of the available treatment options for frostbite. Over the last 10 years, frostbite management has improved with clear guidelines and management protocols available for both the medically trained and winter sports enthusiasts. Many specialist surgeons are unaware that patients with severe frostbite injuries presenting within 24 h of the injury may be good candidates for treatment with either TPA or iloprost.

In this review, we aim to give a brief overview of field frostbite care and a practical guide to the hospital management of frostbite with a stepwise approach to thrombolysis and prostacyclin administration for clinicians

Coup de chaleur: Bases

clic sur ll'image pour accéder au document

 

Coup de chaleur: Refroidir

Hyperthermie d’effort : comment refroidir ?

Rousseau JM - Congès Urgences 2008

Coup de chaleur: Explorer

Hyperthermie d’effort : pourquoi explorer ?

Saby C et All. Congrès Urgences 2008

Les gelures

 

clic sur l'image pour accéder au document

Histoire de température

Clic sur l'image pour accéder au document

Cold weather: Epidémio US

Cold weather injuries, active and reserve components, U.S. Armed Forces, July 2008-June 2013.

Armed Forces Health Surveillance Center (AFHSC) MSMR. 2013 Oct;20(10):12-7

Hypothermie  Engelures  Gelures  Pied de tranchée

Facteurs de risque: Jeune, de sexe féminin, ascendance africaine

Rate per 100,000 person-years

Hypothermie: Isoler étanche même mouillé est efficace !

 Protection against Cold in Prehospital Care: Evaporative Heat Loss Reduction by Wet Clothing Removal or the Addition of a Vapor Barrier—A Thermal Manikin Study

Henriksson O. et Al. Prehosp Disaster Med 2012;26(6):1–6

 Le travail présenté met en exergue les points suivants:

1. Le fait d'envelopper un organisme dans un contenant limite les pertes thermiques par évaporation .

2 Il est meilleur de multiplier les couches d'isolation.

Il est fondamental que cet isolement soit parfaitement ETANCHE à l'air. 

On rappelle que le principe de l'oignon (technique de hibbler)

source

1. La mise en place d'un écran interne au contact du blessé pour réduire les pertes thermiques par RADIATION (pertes thermiques par émission de rayonnement infrarouge, 50%des pertes) et par EVAPORATION (perte de calorie liée au changement d'état des molécules d'eau)  (cutanée: 22 % des pertes et également respiratoire: 10 % des pertes) ainsi qu'en en protégeant les couches externes d'isolation de la transpiration et ou des défécations qui pourraient alors majorer les pertes par conduction. Ex: Une couverture de survie.

2. L'emballage par au moins 2 couches d'isolation interne pour permettre d'emmagasiner de la châleur. Ex: un sac de couchage ou des couvertures.

3. La mise en place de chaufferettes sans contact direct avec la peau pour permettre un réchauffement externe sans occasionner de brûlures cutanées.

4. Une  couche externe  étanche à la vapeur réduit les pertes par EVAPORATION en protégeant les couches internes d'isolation de l'eau externe (pluie, neige, humidité du sol) et réduit les pertes par CONVECTION (15 % des pertes,  liée au vent. Ex une couverture de survie.

5. L'isolation du sol réduit les pertes par CONDUCTION (transfert de calories par contact direct entre deux corps, 3% des pertes ). Ex: un tapis de sol.

 

Mal des montagnes: Actualisation

Clic pour accéder au document

Cet article fait l'objet de nombreux commentaires à lire ici

Combat en altitude: Le point de vue OTAN

Point sur les technologies associées à la médecine militaire de montagne et les freins à la recherche

Final Report of Task Group HFM-146

Altitude acclimatization and illness management

http://armypubs.army.mil/med/dr_pubs/dr_a/pdf/tbmed505.pdf

Médecine de montagne

http://dium.free.fr/joomla/index.php

Manuel de survie US

http://citerahiadesgenettes.hautetfort.com/list/milieux-d...

Medical Aspects of Harsh Environments

Volume 1     Volume 2

Ibuprofen pour le mal des montagnes

L'utilisation du diamox est reconnu pour la prévention du mal aigu des montagnes (Lire l'article). L'ibuprofen serait également efficace.

 

Ibuprofen Prevents Altitude Illness: A Randomized Controlled Trial for Prevention of Altitude Illness With Nonsteroidal Anti-inflammatories

Lipman GS et all. doi:10.1016/j.annemergmed.2012.01.019

Study objective

Acute mountain sickness occurs in more than 25% of the tens of millions of people who travel to high altitude each year. Previous studies on chemoprophylaxis with nonsteroidal anti-inflammatory drugs are limited in their ability to determine efficacy. We compare ibuprofen versus placebo in the prevention of acute mountain sickness incidence and severity on ascent from low to high altitude.

Methods

Healthy adult volunteers living at low altitude were randomized to ibuprofen 600 mg or placebo 3 times daily, starting 6 hours before ascent from 1,240 m (4,100 ft) to 3,810 m (12,570 ft) during July and August 2010 in the White Mountains of California. The main outcome measures were acute mountain sickness incidence and severity, measured by the Lake Louise Questionnaire acute mountain sickness score with a diagnosis of ≥ 3 with headache and 1 other symptom.

Results

Eighty-six participants completed the study; 44 (51%) received ibuprofen and 42 (49%) placebo. There were no differences in demographic characteristics between the 2 groups. Fewer participants in the ibuprofen group (43%) developed acute mountain sickness compared with those receiving placebo (69%) (odds ratio 0.3, 95% confidence interval 0.1 to 0.8; number needed to treat 3.9, 95% confidence interval 2 to 33). The acute mountain sickness severity was higher in the placebo group (4.4 [SD 2.6]) than individuals receiving ibuprofen (3.2 [SD 2.4]) (mean difference 0.9%; 95% confidence interval 0.3% to 3.0%)

.Conclusion

Compared with placebo, ibuprofen was effective in reducing the incidence of acute mountain sickness.

Military Mountaineering

http://ps-survival.com/PS/Military_FMs/FM_3-97_61c1_Milit...

Port de charges

Le port de charges lourdes est un élément important à prendre en compte. Vous ne devez pas vous charger de manière inconsidérée. Un équilibre est à trouver entre ce qui est nécessaire pour le combat, l'hydratation, l'alimentation, le matériel santé et VOS CAPACITES PHYSIQUES. Le lien suivant aborde la problématique vue par les américains.

http://www.bordeninstitute.army.mil/other_pub/LoadCarriag...

Le traitement de l'eau

MJAFI 2009; 65 : 260-263

Household Water Purification: Low-Cost Interventions

Col VK Agrawal (Retd)*, Brig R Bhalwar+

Abstract

Numerous studies have shown that improving the microbiological quality of household water by point-of-use treatment reduces diarrhoea and other waterborne diseases. The most promising and accessible of the technologies for household water treatment are filtration with ceramic filters, chlorination with storage in an improvised vessel, solar disinfection in clear bottles by  the combined action of UV radiation and heat, thermal disinfection (pasteurization) in opaque vessels with sunlight from solar cookers or reflectors and combination systems employing chemical coagulation-flocculation, sedimentation, filtration and chlorination. However each of these technologies have limitations and effectiveness can be increased by use of two or more treatment systems in succession for improved treatment and the creation of multiple barriers. In particular those treatments that provide no residual disinfectant, such as boiling, solar treatment, UV disinfection with lamps and filtration could be followed by chlorination to provide a multibarrier approach. Water purifiers based on multiple interventions such as filtration/ultra filtration/ activated carbon adsorption / UV rays disinfection are available in the market which can be used to purify the water at point of use. Water purifiers based on single interventions like candle filters, resins filters or ultraviolet lamp can be used in most places being supplied water after purification. Troops on operational move can purify water by fabric/resins filtration and chlorine disinfection or by flocculent-disinfectant.

 

Altitude et acclimatation: Pas si simple

Determinants of Acclimatisation in High Altitude

Col VS Syed*, Maj Gen S Sharma+, Col RP Singh#

Abstract

Background: A total of 31 cases of effects of high altitude were admitted to a field hospital from a particular sector during the year 2008.  This study was hence undertaken to see the efficacy of acclimatisation as well as outline the determinants of acclimatisation

Methods: The study monitored the transients in the acclimatisation period as well as laid down the guidelines to certify the fitness after the acclimatisation period.

Result: Almost 4.70% of transients were found unfit to proceed to higher altitudes even after acclimatisation. Tachycardia with oxygen saturation below 90% by digital pulse oximetry were the parameters found to be statistically significant as an indicator declare a person as not fully acclimatised or otherwise.

Conclusion: The administrative authorities must ensure that an individual is fully acclimatized, based on the fitness certificat

issued, before being dispatched to their units located in high altitude areas.

MJAFI 2010; 66 : 261-265