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3.
Ann Biol Clin (Paris) ; 72(6): 735-8, 2014.
Article in French | MEDLINE | ID: mdl-25486670

ABSTRACT

Acute arsenic poisoning is a rare cause of suicide attempt. It causes a multiple organs failure caused by cardiogenic shock. We report the case of a patient admitted twelve hours after an ingestion of trioxide arsenic having survived thanks to a premature treatment.


Subject(s)
Arsenic Poisoning , Oxides/poisoning , Acute Disease , Adult , Arsenic Poisoning/complications , Arsenic Poisoning/diagnosis , Arsenic Trioxide , Arsenicals , Humans , Male , Multiple Organ Failure/etiology , Suicide, Attempted
4.
Intensive Care Med ; 40(1): 66-73, 2014 Jan.
Article in English | MEDLINE | ID: mdl-23974524

ABSTRACT

PURPOSE: Use of ultrasound (US) when introducing central venous catheters (CVC) may improve success rates, reduce the number of needle punctures, and decrease complication rates, but has been hampered by supposed difficulty in learning how to perform the technique. This study describes the learning curve for US-guided jugular CVC placement after a training program. METHODS: After an initial slide presentation and a video, intensivists who had not previously used US for CVC placement were evaluated qualitatively for US set up (score S1) and technical skills (score S2). Quantitative measures included durations of different components of the procedure (T1, time from entry of the US into the patient's room to sterile dressing of the intensivist; T2, time needed for sterile drapes, venous line preparation, and sterile sheath placement; T3, time from skin puncture to venous flashback; T4, time from guide insertion to dressing; T(tot), total duration of the procedure); number of skin punctures; and a difficulty score allocated by the intensivist. RESULTS: We performed 150 evaluations of 30 intensivists: 50% had no prior experience of CVC placement and 50% no prior US experience. Maximal S1 and S2 scores were obtained with the fourth and eighth placement procedures, respectively. T1 and T2 did not change with ongoing training (5 and 8 min, respectively), but T3 and T4 decreased, from 5 min (first procedure) to less than 1 min (seventh procedure), and from 10 min (first procedure) to 7 min (sixth procedure), respectively. T(tot) decreased from 34 to 21 min at the eighth procedure. The number of skin punctures and the difficulty score decreased rapidly with the number of evaluations. CONCLUSIONS: Our study demonstrates that skills in US-guided CVC placement can easily be acquired with training.


Subject(s)
Catheterization, Central Venous/methods , Jugular Veins/diagnostic imaging , Medical Staff, Hospital/education , Ultrasonography, Interventional/methods , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/instrumentation , Educational Measurement , Female , France , Humans , Inservice Training/methods , Intensive Care Units/standards , Learning Curve , Male , Middle Aged , Ultrasonics/education , Ultrasonography, Interventional/instrumentation , Workforce
5.
Ann Biol Clin (Paris) ; 71(4): 485-8, 2013.
Article in French | MEDLINE | ID: mdl-23906581

ABSTRACT

Succinylcholine is a short-term curare which degradation depends on its quick hydrolysis by butyrylcholinesterase (or pseudocholinesterase). Thus, a butyrycholinesterase deficiency, congenital or acquired, is a cause of a prolonged neuromuscular block. From an autosomal recessive inheritance, genetic deficiency remains the first etiology. The most frequently discussed variant is the atypical variant which caused a 2 hours prolonged curarisation after administration of succinylcholine. We report a patient who had a prolonged curarisation after succinylcholine's injection, due to a congenital butyrylcholinestérase deficiency and contributed by a lithium treatment. Extubation was only possible 7 hours after administration of curare.


Subject(s)
Lithium Compounds/adverse effects , Metabolism, Inborn Errors/complications , Neuromuscular Blockade/adverse effects , Neuromuscular Depolarizing Agents/adverse effects , Succinylcholine/adverse effects , Aged , Apnea , Bipolar Disorder/drug therapy , Bronchoscopy/methods , Butyrylcholinesterase/deficiency , Drug Synergism , Humans , Intubation, Intratracheal , Lung Neoplasms/diagnosis , Male , Time Factors
6.
Ann Biol Clin (Paris) ; 71(1): 113-9, 2013.
Article in French | MEDLINE | ID: mdl-23396435

ABSTRACT

We report a case of a 47 years old woman. In her case of medical history, there were vein thrombosis and an allergic to tinzaparin. The patient entered in critical care unit under medical supervision for a multivisceral infarction due to an arterial mesenteric, renal and splenic thrombosis. An heparinotherapy was introduced. A laparotomy was realized because of an occlusion. Small intestine necrozed was removed. 8 days after the introduction of the heparin, there was a thrombocytopenia. Considering the background and the initiale situation, an heparin-induced thrombocytopenia of type II (HTI) was suspected. Whereas the heparinotherapy was stopped, the thrombocytopenia maked worse. Biological tests infirmed HIT's diagnosis. A recurrent anemia in spite transfusions associated to a renal failure suggest a thrombotic microangiopathy which was secondary confirmed. The intensivist is sensibilized to evoke an heparin induced thrombocytopenia when there is a thrombocytopenia under heparin. However, he must not forget diagnosis of thrombocytopenia which required specific investigations and emergency treatment such as thrombotic microangiopathy.


Subject(s)
Heparin/adverse effects , Thrombocytopenia/chemically induced , Thrombocytopenia/diagnosis , Thrombotic Microangiopathies/diagnosis , Diagnosis, Differential , Female , Hematology/methods , Humans , Middle Aged
7.
Ann Biol Clin (Paris) ; 70(6): 733-40, 2012.
Article in French | MEDLINE | ID: mdl-23207821

ABSTRACT

Falciparum malaria is a potentially deadly infectious disease, imposing a sure and fast biologic diagnosis, an early and efficient treatment. We report a case of severe imported Falciparium malaria who received artesunate, and we rewiew the different diagnostic methods of malaria as well as the clinico-biological characteristics of severe malaria. Recent data concerning malaria treatment are presented, as a pharmacokinetic study leaded during this case.


Subject(s)
Antimalarials/therapeutic use , Artemisinins/therapeutic use , Malaria, Falciparum/diagnosis , Malaria, Falciparum/drug therapy , Plasmodium falciparum/drug effects , Antimalarials/administration & dosage , Artemisinins/administration & dosage , Artesunate , Central African Republic , Chromatography, Affinity , Humans , Injections, Intravenous , Malaria, Falciparum/parasitology , Male , Middle Aged , Plasmodium falciparum/isolation & purification , Polymerase Chain Reaction , Severity of Illness Index , Travel , Treatment Outcome
8.
Anesth Analg ; 113(5): 1052-7, 2011 Nov.
Article in English | MEDLINE | ID: mdl-21918163

ABSTRACT

BACKGROUND: In March 2008, a new multiwavelength pulse oximeter, the Radical 7 (Rad7; Masimo Corp., Irvine, CA), was developed that offers noninvasive measurement of hemoglobin concentration. Accuracy has been established in healthy adults and some surgical patients, but not in cardiac surgery intensive care patients, a group at high risk of postoperative bleeding events and anemia in whom early diagnosis could improve management. METHODS: In this prospective, observational study conducted in a cardiovascular intensive care unit, we compared hemoglobin concentrations shown by the Rad7 with arterial hemoglobin concentrations determined by an automated hematology analyzer, XE-2100 (Roche, Neuilly sur Seine, France). Two software versions of Rad7 (V 7.3.0.1 [42 points of comparison in 14 patients] and the updated V 7.3.1.1 [61 points of comparison in 27 patients]) were studied during two 1-week periods. Bias, defined as the difference between the 2 methods (Masimo SpHb-XE-2100 laboratory hemoglobin), was calculated. A negative bias indicated that the Masimo underestimated hemoglobin compared with the laboratory analyzer. Correlation between the perfusion index given by Rad7 and the hemoglobin bias was also studied. RESULTS: Correlations between Rad7 and XE-2100 were weak for both software versions (R2=0.11 for V 7.3.0.1 and R2=0.27 for V 7.3.1.1). Mean bias was -1.3 g/dL for V 7.3.0.1 and -1.7 g/dL for V 7.3.1.1, with wide 95% prediction intervals for the bias (respectively, -4.6 to 2.1 g/dL and -5.7 to 2.3 g/dL). The absolute hemoglobin bias tended to increase when the perfusion index decreased. For the V 7.3.0.1 software, the average absolute bias was 1.9 g/dL for perfusion index<2 and 0.8 g/dL for perfusion index>2 (P=0.03). For V 7.3.1.1, the mean absolute bias was 2.1 g/dL when the perfusion index was <2, and 1.6 g/dL when the perfusion index was >2 (P=0.26). CONCLUSIONS: Our study demonstrates poor correlation between hemoglobin measured noninvasively by multiwavelength pulse oximetry and a laboratory hematology analyzer. The difference was greater when the pulse oximetry perfusion index was low, as may occur in shock, hypothermia, or vasoconstriction patients. The multiwavelength pulse oximetry is not sufficiently accurate for clinical use in a cardiovascular intensive care unit.


Subject(s)
Cardiac Surgical Procedures/methods , Hemoglobinometry/instrumentation , Oximetry/instrumentation , Aged , Critical Care , Female , Humans , Male , Middle Aged , Monitoring, Physiologic , Postoperative Period , Prospective Studies , Regional Blood Flow/physiology , Reproducibility of Results , Software
10.
Ann Biol Clin (Paris) ; 69(2): 202-7, 2011.
Article in French | MEDLINE | ID: mdl-21464014

ABSTRACT

We report a case of a female patient of 47 years old who presents in a state of septic shock with acute insufficient respiratory complicated with syndrome of acute respiratory distress, together with a list of abdominal pain and polyarthralgia too. In her case of medical history, it is retained that she has had a intra-uterine device since 6 years without medical follow up. The initial thoraco-abdomino-pelvic scan shows a left ovarian vein thrombosis, as well as the opaqueness alveolus diffused interstitiel bilaterally and an aspect of ileitis. The IUD is taken off because of sudden occuring of purulent leucorrhoea. This results in a clinical and paraclinical improvement, whereas aminopenicillin was administered to the patient since 1 week. The microbiological blood test allows to put in evidence Fusobacterium necrophorum found in a blood culture and is sensitive to the amoxicilline-acide clavulanique and metronidazole. Isolation of this bacteria, classically found in Lemierre's syndrome, allowed to explain the multilfocalization of the symtoms and the list of pain. The whole concerns about a variant of Lemierre's syndrom: a state of septic shock secondary then caused by the anaerobic Gram negative bacilli, which is a commensal bacteria of the female genital tractus, complicated of septic emboli typical.


Subject(s)
Fusobacterium Infections/complications , Fusobacterium necrophorum , Lemierre Syndrome/etiology , Respiratory Distress Syndrome/etiology , Shock, Septic/complications , Female , Humans , Intrauterine Devices , Middle Aged
12.
Ann Biol Clin (Paris) ; 68(2): 234-8, 2010.
Article in French | MEDLINE | ID: mdl-20348051

ABSTRACT

We report the case of a 35-year-old woman hospitalized in intensive care unit after valpromide self-poisoning (Dépamide). The dose supposed to be taken was 15 g. The patient eleven hours after ingestion, presented, a coma with bilateral non-reactive mydriasis, justifying intubation and mechanical ventilation. An acidosis (pH = 7.24), a hyperlactatemia (2.72 mmol/L), a hyperammonemia (328.9 micromol/L), and were diagnosed valproic acid plasmatic concentration was 1190 microg/mL at 22 hours. Symptomatic treatment and L-carnitine therapy (50 mg/kg/12h) normalized the action of biological abnormalities and allowed disappearance of symptoms; the patient was extubated after 46 hours, and outcome from intensive care unit at 65 hours.


Subject(s)
Anticonvulsants/poisoning , Poisoning/blood , Valproic Acid/analogs & derivatives , Acidosis/chemically induced , Adult , Ammonia/blood , Carnitine/therapeutic use , Female , Humans , Lactates/blood , Respiration, Artificial , Time Factors , Treatment Outcome , Valproic Acid/blood , Valproic Acid/pharmacokinetics , Valproic Acid/poisoning
13.
Am J Geriatr Pharmacother ; 6(3): 173-7, 2008 Aug.
Article in English | MEDLINE | ID: mdl-18775393

ABSTRACT

BACKGROUND: Bleeding is the most serious complication of oral anticoagulant therapy used for the prevention of thromboembolic complications. Drug-drug interactions are an important concern, as they may increase drug toxicity and, in the case of anticoagulant therapies, increase the risk of hemorrhage. CASE SUMMARY: An 84-year-old woman presented to the emergency department with a bilateral cervical hematoma and symptoms of upper-airway obstruction that had been increasing for 72 hours, with dyspnea and difficulty speaking developing in the previous 24 hours. Transnasal fiberoptic laryngoscopy revealed a significant laryngeal hematoma, as well as a hematoma on the floor of the mouth and in the tonsil area. Laboratory abnormalities included a prothrombin time < 10%, an international normalized ratio exceeding the laboratory limits, and an activated partial thromboplastin time >120 seconds. The patient had been receiving acenocoumarol 4 mg/d for 10 years for episodes of atrial fibrillation and recurrent deep venous thrombosis. Seventeen days earlier, she had received a prescription for topical econazole lotion 1% to be applied 3 times daily for 1 month to treat a dermatitis affecting 12% of the body surface. The patient was admitted to the intensive care unit for treatment of respiratory failure, where oxygen was delivered by face mask. The coagulation disorders were treated with prothrombin complex concentrate 30 IU/kg IV and vitamin K1 10 mg IV, and values normalized within 36 hours. Surgical evacuation of the laryngeal hematoma was not necessary. After 48 hours, improvement in the patient's respiratory symptoms allowed transfer to the ear, nose, and throat unit, where daily endoscopic examination was performed. Aspirin was substituted for acenocoumarol, and the patient returned home after 10 days without sequelae. Based on a Naranjo score of 7, this episode was probably related to an interaction between acenocoumarol and econazole. CONCLUSION: This report describes a case of a probable interaction between topical econazole lotion 1% and acenocoumarol that resulted in overanticoagulation and a life-threatening laryngeal hematoma in this elderly patient.


Subject(s)
Acenocoumarol/adverse effects , Anticoagulants/adverse effects , Antifungal Agents/adverse effects , Blood Coagulation Disorders/diagnosis , Dyspnea/chemically induced , Econazole/adverse effects , Laryngeal Diseases/chemically induced , Administration, Topical , Aged, 80 and over , Antifungal Agents/administration & dosage , Aspirin/therapeutic use , Blood Coagulation Disorders/blood , Blood Coagulation Disorders/drug therapy , Drug Interactions , Econazole/administration & dosage , Female , Hematoma/etiology , Hematoma/pathology , Humans , Laryngoscopy , Platelet Aggregation Inhibitors/therapeutic use , Prothrombin/therapeutic use
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