[Screening for carbon monoxide (CO) poisoning by general practitioners in home visits]. / Dépistage des intoxications au monoxyde de carbone (CO) par des médecins généralistes effectuant des visites à domicile.

OBJECTIVE: To evaluate the interest of carbon monoxide (CO) detector used by general practionners visiting patients at home. METHODS: CO detector (cost: 200 euros) was attributed to 300 general practionners visiting at least 20 patients at home per week. Alarm was triggered when ambient CO concentration exceeded 80ppm. Measurement of CO in expired breath was also possible. Activity and alarms were prospectively collected. Circumstances of intoxication were recorded. Evaluation was finally performed. The end-poind was to quantify CO-poisoning detected by the use of the device and the cost of this stratégy. RESULTS: From November 2001 to November 2004, 65 scenes of intoxication with 79 victims were prospectively reported by 12 general practionners. Final evaluation revealed that 23 physicians omitted to declare alarms. Alarm incidence was of 1 for 17.527 visits; with a related cost of approximately 858 euros for 24 months. Ambient carbon monoxide concentration exceeded 200ppm in 25% of cases. Hospital admission was required for 91% of the victims. Hyperbaric oxygen therapy was performed in two cases. General practionners (n=272) considered that CO detector was useful for safety reasons (91%), they wanted to continue the experience, but did not plan to buy such device (59%). DISCUSSION: Use of CO detectors by general practionners visiting patients at home allowed to identify 65 scenes of CO intoxication. In most cases, the cause of the visit did not suggested CO poisoning. The cost of the device seems to limits its large use. CONCLUSION: CO detector is a safety tool for both general prationners and patients. Its large use has to be questioned.

Prospective evaluation of peripheral venous access difficulty in emergency care.

OBJECTIVE: Although frequently used and crucial in emergency care, peripheral intravenous access has been poorly documented. We examined whether criteria related to patient characteristics, underlying disease, devices, or environment were associated with difficult peripheral intravenous access. DESIGN AND SETTING: Prehospital prospective observational study. PARTICIPANTS AND MEASUREMENTS: For each peripheral intravenous access attempt a questionnaire was filled in until final success or procedure abandonment. This questionnaire included data on the patient, operator, disease, degree of emergency, cannulation, nature of fluid infused and the use of gloves, environment, and particular medical observations such as recent peripheral intravenous access and chemotherapy. Criteria associated with peripheral intravenous access difficulty were identified comparing successful and unsuccessful attempts. A total of 671 attempts at peripheral intravenous access in 495 patients were studied. RESULTS: The first attempt was successful in 368 cases (74%) and unsuccessful in 127 (26%). Final success was reported in all cases, including the use of central venous access in three cases. No abandonment was reported. Significantly correlated with a successful attempt were: the caliber of the catheter (OR 0.793), cannulation performed by a nurse specialized in emergency care (OR 3.959), lack of particular observations (OR 0.120), and a clean patient (OR 0.505). CONCLUSIONS: Peripheral intravenous access was achieved in 99% of the patients in out-of-hospital settings. Improved success rate was reported when attempts were performed by a nurse specialized in emergency care using a 16- or 18-G catheter in clean patients without a particular medical history.

[Determination of early markers of a sanitary event. The example of the heat wave of August 2003 at the Samu 93-centre 15 in France]. / Détermination des indicateurs précoces d'une crise sanitaire. L'exemple de la canicule d'août 2003 au Samu 93-centre 15.

OBJECTIVE: The aim of this study was to determine, a posteriori, the parameters detecting an event in a French medical emergency dispatching centre (SAMU). METHODS: Six parameters were retained: total number of medical requests received by the Samu 93-centre 15: the number of decisions to send a mobile intensive care unit (MICU), number of decisions to send a non-medical unit, number of decisions to send a general practitioner and number of deaths observed by the physicians of the MICU. For each parameter, a daily referential was established over the five previous years (1998 to 2002) and compared with the results of August 2003 RESULTS: The number of decisions to send a non-medical unit and the number of decisions to send a general practitioner were unchanged. The number of deaths on the 8th of August observed by the MICU physician should have led to an alert being given: 5.0 deaths for a referential of 1.7 (+ 194%). The number of decisions to send an MICU on the 7th of August should have led to an alert being given: 41 interventions for a referential of 25 (+64%). The number of medical interventions on the 6th of August should have led to an alert being given: 351 interventions for a referential of 299 (+17%). CONCLUSION: The total number of medical interventions treated by the SAMU 93-centre 15 is a the most sensitive and earliest marker of a sanitary event, such as that observed in August 2003 with the heat wave.