[The intraosseous infusion in adult]. / La perfusion intraosseuse chez l'adulte.

Intraosseous infusion is an old knowledge, abandoned in the 1950s in favor of the peripheral vein, and it was essentially described in pediatrics and military medicine. Since 2005, this way is experiencing a resurgence of interest in emergency medicine particularly in adults after the failure's installation of a peripheral vein in order not to waste the time of care and administration of treatment. New devices that allow intraosseous infusion are currently used in humans. We propose to review the different kind of catheters used, to know the main technical characteristics, indications, contraindications and potential complications. We propose a comparison with the peripheral vein and a comparison between the different catheters.

[Helium-sevoflurane association: a rescue treatment in case of acute severe asthma]. / Association hélium-sévoflurane : une thérapeutique de sauvetage dans l'asthme aigu grave.

We report the case of a severe acute asthma, which required, after optimal medical therapy, helium and sevoflurane CO-administration after tracheal intubation. The Anesthetic Conserving Device allowed sevoflurane use with intensive care unit's ventilator. The helium-sevoflurane association was maintained during 9 days to decrease the bronchospasm, waiting for the efficiency of an aetiologic treatment. We discuss the suitability of this association to treat severe acute asthma, and its administration modalities.

[The Main Gate Syndrome: a new format in mass-casualty victim "surge" management?]. / Le Main Gate Syndrom ou faut-il redéfinir notre conception du triage chirurgical?

INTRODUCTION: Recent suicide bombings pose the novel problem for Trauma Centers of the massive simultaneous arrival of many gravely wounded patients. METHODS: We report the experience of the French-German Military Trauma Group, a Level 2 Trauma Center, in Afghanistan during the wave of suicide bombings in February 2007. RESULTS: Fourteen casualties were received. A first triage was carried out by the U S Army Level I group prior to evacuation. A second surgical triage was carried out with systematic ultrasound exam. Four cases (ISS>25) were re-categorized and underwent emergency surgical procedures. CONCLUSION: Suicide bombing in crowded locations near an evacuation hospital may overwhelm the medical resources of the receiving center. It has been referred to as "The Main Gate Syndrome." We introduced the novel concept of a semi-evacuation hospital or receiving center where a second surgical triage was carried out. These exceptional circumstances require open-minded flexibility, a tailored approach, and close cooperation between surgeons and anesthetists to share experience, opinions, and ideas. In the setting of mass casualties, emergency ultrasound exam was shown to be a valuable and effective tool by virtue of its mobility, reproducibility, and immediate results.

[Bacterial meningitis in HIV patient: think about co-infections!]. / Méningite bactérienne chez le patient VIH positif: pensez aux co-infections!

The authors report the case of an African 34-year-old patient who was admitted to the intensive care unit for bacterial meningitis due to Streptococcus pneumoniae. A meningeal co-infection due to Cryptococcal neoformans was found the 3rd day in an HIV infection context. Cryptococcus neoformans detection in cerebrospinal fluid, using the India-ink stain, has a low sensibility which imposes the search of cryptococcal antigen and the culture of cerebrospinal fluid. These last two exams have a sensibility of at least 90%.

[Premixed 50% nitrous oxide and oxygen: theoretical recalls and practical modalities]. / Mélange équimolaire oxygène-protoxyde d'azote (MEOPA). Rappels théoriques et modalités pratiques d'utilisation.

The concept of premixed 50% nitrous oxide and oxygen dated back to 1961 in England, where it is commercialised under the name Entonox. In France, after a so marginal use, premixed 50% nitrous oxide and oxygen now knows such a revival since we first consider the pain provoked by the cure. To use correctly premixed 50% nitrous oxide and oxygen, we need to know the main properties of the nitrous oxide. The four commercial versions, now on the market, are presented (Kalinox, Medimix, Antasol, Oxynox. Except a few contraindications, these indications are large, as well at hospital as outside. In less than 10% of the cases, side effects are possible. Conditions of administration are given in details. The limits of the technic and the particular precautions of use are precised.

Influence of polyunsaturated fatty acid diet on the hemorrheological response to physical exercise in hypoxia.

Several studies have shown that hemorrheological parameters are modified by physical exercise and exposure to altitude hypoxia. These changes result in a decrease in red cell deformability (RCD). Similarly, it has been shown that a daily dietary fish oil supplement increases RCD. The purpose of this study was to evaluate the influence of fish oil diet on RCD after exercise. Fourteen male subjects (19-38 years old) were divided into two groups. The first group ate a "standard diet" rich in saturated lipids; the second group received a daily amount of 6 g of MaxEPA fish oil for 6 weeks. Before the 6 weeks of experimental nutrition, and just after this period, both groups were submitted to two physical exercises of 1 h cycling at 70% of their VO2max. One test was performed at sea level, the other at a simulated altitude of 3000 m in a hypobaric chamber. Blood samples were drawn before and after exercise and used to evaluate: (1) RCD by filtration on polycarbonate membrane, (2) plasma viscosity, and (3) erythrocyte phospholipid composition. Energy charge of red cell was evaluated by ATP/AMP/ADP and two to three DPB assays. Gas liquid chromatography indicated an increase in n-3 PUFA membrane erythrocyte composition. In the control group, RCD decreased by an average of 53% after exercise under hypoxic conditions and was unchanged after the same exercise at sea level. MaxEPA diet suppresses the decrease in RCD observed after hypoxic exercise. These results indicate a decrease in RCD under the combined effects of exercise and hypoxia, which is prevented by 6 weeks of fish oil supplement.