Laboratory study on the kinetics of the warming of cold fluids-A hot topic.

OBJECTIVES: In case of mild therapeutic hypothermia after an out-of-hospital cardiac arrest, several techniques could limit the cold fluid rewarming during its perfusion. We aimed to evaluate cold fluid temperature evolution and to identify the factors responsible for rewarming in order to suggest a prediction model of temperature evolution. EQUIPMENT AND METHODS: This was a laboratory experimental study. We measured temperature at the end of the infusion line tubes (ILT). A 500ml saline bag at 4°C was administered at 15 and 30ml/min, with and without cold packs applied to the cold fluid bag or to the ILT. Cold fluid temperature was integrated in a linear mixed model. Then we performed a mathematical modelization of the thermal transfer across the ILT. RESULTS: The linear mixed model showed that the mean temperature of the cold fluid was 1°C higher (CI 95%: [0.8-1.2]) with an outflow rate of 15 versus 30ml/min (P<0.001). Similarly, the mean temperature of the cold fluid was 0.7°C higher (CI 95%: [0.53-0.9]) without cold pack versus with cold packs (P<0.001). Mathematical modelization of the thermal transfer across the ILT suggested that the cold fluid warming could be reduced by a shorter and a wider ILT. As expected, use of CP has also a noticeable influence on warning reduction. The combination of multiple parameters working against the rewarming of the solution should enable the infusion of a solute with retained caloric properties. CONCLUSIONS: By limiting this "ILT effect," the volume required for inducing mild therapeutic hypothermia could be reduced, leading to a safer and a more efficient treatment.

In-flight auscultation during medical air evacuation: comparison between traditional and amplified stethoscopes.

OBJECTIVES: The aim of this study was to evaluate the capacity of a traditional stethoscope versus an electronically amplified one (expected to reduce background and ambient noise) to assess heart and respiratory sounds during medical transport. MATERIALS AND METHODS: It was a prospective, double-blinded, randomized performed study. One traditional stethoscope (Littmann Cardiology III; 3M, St Paul, MN) and 1 electronically amplified stethoscope (Littmann 3200, 3M) were used for our tests. Heart and lung auscultation during real medical evacuations aboard a medically configured Falcon 50 aircrafts were studied. The quality of auscultation was ranged using a numeric rating scale from 0 to 10 (0 corresponding to "I hear nothing" and 10 to "I hear perfectly"). Data collected were compared using a t-test for paired values. RESULTS: A total of 40 comparative evaluations were performed. For cardiac auscultation, the value of the rating scale was 4.53 ± 1.91 and 7.18 ± 1.88 for the traditional and amplified stethoscope, respectively (paired t-test: P < .0001). For respiratory sounds, quality of auscultation was estimated at 3.1 ± 1.95 for a traditional stethoscope and 5.10 ± 2.13 for the amplified one (paired t-test: P < .0001). CONCLUSIONS: This study showed that practitioners would be better helped in hearing cardiac and respiratory sounds with an electronically amplified stethoscope than with a traditional one during air medical transport in a medically configured Falcon 50 aircraft.

[Nurses with the Paris Fire Brigade]. / Infirmier à la Brigade de sapeurs-pompiers de Paris.

The army nurses of the Paris Fire Brigade serve the population of Paris and three adjacent departments. They receive induction as well as continuous training and work within the mobile pre-hospital medical teams. In addition to their day-to-day support of firefighters, they train, teach and participate in clinical research and development.

[Health problems of combatants during the First World War]. / Les problèmes de santé des combattants durant la Première Guerre mondiale.

The First World War because of the use of new weapons, injured more than 3 500 000 people (500 000 in the face), more than diseases (tuberculosis, typhoid fever, etc.) or even weather circumstances. The healing of the war wounds through surgery undertook a significant evolution thanks to the use of asepsis and antiseptics. Mortality go down, opening the way to the physical and psychological rehabilitation of those injured by the war.

[Wound care during the First Word War]. / Les soins des plaies au quotidien durant la Première Guerre mondiale.

Following the sanitary disaster which occurred during the first months of First Word War, the French Military Health System has structured itself. Focus was made on effective surgical sorting for stabilization aids before evacuation. The functional prognosis of the war injured individual as his survival has been significantly improved. We report nurses' testimonies, for some unpublished yet: challenging aids, especially wounds.

Stroke: prospective evaluation of a prehospital management process based on rescuers under medical direction.

BACKGROUND: Improving access to thrombolytic therapy for patients with ischemic stroke is challenging. We assessed a prehospital process based on firemen rescuers under strict medical direction, aimed at facilitating thrombolysis of eligible patients. METHODS: This was a prospective observational study conducted over 4 months in Paris, France. Prehospital patients with suspected stroke were included after telephone consultation with a physician. If the time since the onset of symptoms was less than 6 hours, patients were transported directly to a neurovascular unit (NVU); if symptom onset was more than 6 hours ago, they were transported to an emergency department (ED). Confirmation of stroke diagnosis, the rate of thrombolysis, and the time intervals between the call and hospital arrival and imaging were assessed. Comparison used Fisher exact test. RESULTS: Of the 271 patients transported to an NVU, 218 were diagnosed with a stroke (166 with ischemic stroke), 69 received thrombolytic therapy, and the mean stroke-thrombolysis interval was 150 minutes. Of 64 patients admitted to the ED, 36 patients had a stroke (ischemic, 24). None were thrombolysed. Globally, 36% of ischemic strokes were thrombolysed (27% of all strokes diagnosed). The mean interval call-hospital was 65 minutes (ED vs NVU, P = .61). The interval call-imaging was 202 minutes (interquartile range, 105.5-254.5) for ED and 92 minutes (interquartile range, 77-116) for NVU (P < .001). CONCLUSIONS: The prehospital management of stroke by rescuers, under strict medical direction, seemed to be feasible and effective for selection of patients with stroke in an urban environment and may improve the access to thrombolysis.

Impact of fibrinolysis on immediate prognosis of patients with out-of-hospital cardiac arrest.

Fibrinolytic therapy (FT) during out-of-hospital cardiac arrest (OHCA) has been studied in several trials, but they have produced unsatisfactory results even in the most recent Thrombolysis in Cardiac Arrest (TROICA) study. This study aimed to assess the impact of FT provided by an out-of-hospital emergency physician on the immediate prognosis of patients with OHCA. We performed a retrospective study in which the primary endpoint was survival to hospital admission. Among 5,102 patients with OHCA in Paris and the suburban area who received medical care from the Fire Brigade of Paris, 1,261 met the following inclusion criteria: age above 18 years with non-traumatic OHCA. Among 107 patients who received FT, 51 (47.7%) survived to hospital admission whereas 272 out of 1,154 (23.6%) patients who did not receive FT survived to hospital admission. A matching process based on a propensity score used to equalise potential prognosis factors in both groups demonstrated that FT was associated with more frequent survival to hospital admission (OR adjusted: 1.7; CI 95% [1.09-2.68]). This result was observed particularly in patients who were not initially shocked by automatic electrical defibrillator (AED) (OR(a) = 3.61; CI 95% [1.88-6.96]). This study showed that fibrinolysis was associated with improved survival to hospital admission, after performing a propensity analysis. FT may be beneficial in out-of-hospital arrest patients. However, any conclusions drawn are limited by the retrospective nature of the study.