ABSTRACT
This case illustrates chest scars after piston-based chest compression device resuscitation and raises the awareness of the potential benefits of following up survivors of critical illness.
ABSTRACT
Emergency medicine is facing many challenges, particularly related to the consequences of the pandemic on the pressure of patient flows and the lack of human resources. More than ever, our discipline seeks to offer our patients quality care based on several recent studies, of which the following is a section: a) Gender effect in the administration of tranexamic acid; b) External validation of the Canadian Syncope Risk Score; c) Role of neuro-imaging in psychiatric decompensation; d) Choice of analgesia in renal colic; e) Use of carotid ultrasound for pulse control in cardiac arrest and f) The safetyness of performing simple sutures in non-sterile conditions.
La médecine d'urgence est confrontée à de nombreux défis, notamment liés aux conséquences de la pandémie sur la pression des flux patients et du manque de ressources médico-soignantes. Plus que jamais, notre discipline cherche à offrir à nos patients des soins de qualité en s'appuyant sur plusieurs études récentes dont voici une sélection : a) effet de genre dans l'administration d'acide tranexamique ; b) validation externe du Canadian Syncope Risk Score ; c) rôle de l'imagerie cérébrale dans les décompensations psychiatriques ; d) choix de l'antalgie dans la colique néphrétique ; e) utilisation de l'US carotidien dans le contrôle du pouls lors d'ACR et f) possibilité de réaliser des sutures simples sans conditions stériles.
Subject(s)
Analgesia , Emergency Medicine , Renal Colic , Humans , Canada , Risk Factors , Analgesia/methodsABSTRACT
Whilst augmented renal clearance (ARC) is associated with reduced ß-lactam plasma concentrations, its impact on clinical outcomes is unclear. This single-centre prospective, observational, cohort study included non-pregnant, critically ill patients aged 18-60 years with presumed severe infection treated with imipenem, meropenem, piperacillin/tazobactam or cefepime and with creatinine clearance (CL(Cr)) ≥60 mL/min. Peak, intermediate and trough levels of ß-lactams were drawn on Days 1-3 and 5. Concentrations were deemed 'subthreshold' if they did not meet EUCAST-defined non-species-related breakpoints. Primary and secondary endpoints were clinical response 28 days after inclusion, and ARC prevalence (CL(Cr)≥130 mL/min) and subthreshold and undetectable concentrations, respectively. Logistic regression was used to evaluate associations between ARC, antibiotic concentrations and clinical failure. From 2010 to 2013, 100 patients were enrolled (mean age, 45 years; median CL(Cr) at inclusion, 144.1 mL/min). ARC was present in 64 (64%) of the patients. Most patients received imipenem/cilastatin (54%). Moreover, 86% and 27% of patients had at least one subthreshold or undetectable trough level, respectively. Among imipenem and piperacillin trough levels, 77% and 61% were subthreshold, respectively, but intermediate levels of both antibiotics were largely above threshold. ARC strongly predicted undetectable trough concentrations (OR=3.3, 95% CI 1.11-9.94). A link between ARC and clinical failure (18/98; 18%) was not observed. ARC and subthreshold ß-lactam antibiotic concentrations were widespread but were not associated with clinical failure. Larger studies are necessary to determine whether standard dosing regimens in the presence of ARC impact negatively on clinical outcome and antibiotic resistance.
