Bibliographie de Médecine d'Urgence

Mois d'avril 2020


Academic Emergency Medicine

Chemical VersusElectrical Cardioversion for AtrialFibrillation.
Bond C, Morgenstern J, Heitz C, Milne WK. | Acad Emerg Med.  2020 Apr;27(4):333-335
DOI: https://doi.org/10.1111/acem.13874  | Télécharger l'article au format  
Keywords: Aucun

HOT OFF THE PRESS

Editorial : Atrial fibrillation (AF) is a significant dysrhythmia that often requires treatment in the emergency department (ED). This can be performed with rhythm control using electrical or chemical cardioversion or with rate control. There is widespread variation in management of AF within Canada and worldwide. This study focuses on rhythm control techniques, comparing ED length of stay when using an electrical-first strategy versus a chemical-first strategy of cardioversion.

Conclusion : In patients in whom a rhythm control strategy is deemed appropriate, this study supports an electrical-first cardioversion strategy for low-risk patients with acute uncomplicated atrial fibrillation. Both chemical-first and electrical-first strategies appear to be successful and well tolerated; however, an electrical-first strategy results in a significantly shorter ED length of stay.

Conclusion (proposition de traduction) : Chez les patients pour lesquels une stratégie de contrôle du rythme est jugée appropriée, cette étude soutient une stratégie de cardioversion en priorité par choc électrique pour les patients à faible risque souffrant de fibrillation atriale paroxystique non compliquée. Les deux stratégies, chimique et électrique, semblent être efficaces et bien tolérées ; cependant, la stratégie électrique se traduit par une durée de séjour beaucoup plus courte.

Anaesthesia and Intensive Care Medicine

Critical care management of adult traumatic brain injury.
Raith EP, Fiorini F, Reddy U. | Anaesth Intensive Care.  2018 Apr;37(2):171-186
DOI: https://doi.org/10.1016/j.mpaic.2020.03.012
Keywords: Aucun

Article in press

Editorial : Severe traumatic brain injury (TBI) is associated with significant morbidity and mortality. The critical care management of TBI requires a coordinated and comprehensive approach to treatment, including strategies to prevent secondary brain injury and maintenance of adequate cerebral perfusion and oxygenation. Management protocols have evolved with international consensus, providing guidelines that assist clinicians in delivering optimal care. Those from the Brain Trauma Foundation are continuously updated to incorporate new trial data ( https://braintrauma.org/coma/guidelines).

Conclusion : The management of traumatic brain injury involves both the management of intracranial pathology and systemic sequelae. Severe traumatic brain injury (TBI) is associated with significant morbidity and mortality. The critical care management of TBI requires a coordinated and comprehensive approach to treatment, including strategies to prevent secondary brain injury and maintenance of adequate cerebral perfusion and oxygenation.

Conclusion (proposition de traduction) : La gestion des traumatismes crâniens implique à la fois la gestion de la pathologie intracrânienne et des séquelles systémiques. Les lésions cérébrales traumatiques graves sont associées à une morbidité et une mortalité importantes. La gestion des soins intensifs des lésions cérébrales traumatiques nécessite une approche coordonnée et globale du traitement, y compris des stratégies visant à prévenir les lésions cérébrales secondaires et à maintenir une perfusion et une oxygénation cérébrales adéquates.

Anaesthesia, Critical Care & Pain Medicine

New Guidelines for the Management of Severe Thermal Burns in the Acute Phase in Adults and Children: Is It Time for a Global Surviving Burn Injury Campaign (SBIC)?.
Holley A, Cohen J, Reade M, Laupland KB, Lipman J. | Anaesth Crit Care Pain Med.  2020 Apr;39(2):195-196
DOI: https://doi.org/10.1016/j.accpm.2020.03.009
Keywords: Aucun

Editorial

Editorial : The World Health Organisation reports that worldwide, 11 million thermally injured patients present annually requiring dedicated specialist services. This cohort of patients constitutes the fourth leading cause of trauma. Significant burns represent a unique form of severe trauma and caring for these patients presents a real challenge for the multidisciplinary team tasked with delivering quality care. Burn severity continues to be reliably determined by depth of the lesion and the total body surface area (TBSA) involved. The prognosis is further affected by extremes of age and presence of a concomitant inhalational injury. Optimal care requires precise initial assessment and, in the appropriate clinical context, transfer to a dedicated burn centre. The subsequent prolonged intensive care admission, surgical intervention, hospitalisation and rehabilitation of thermal injuries, make them among the most time intensive and health care resource demanding presentations.

Conclusion : Finally, we salute the authors for their valuable contribution to the care of this unfortunate population of patients. Perhaps it is now time for the many societies and institutions including, but not exclusively, the French Society of Anaesthesia and Intensive Care Medicine, The Australian and New Zealand Burn Association, the Australian and New Zealand Intensive Care Society, the Interna- tional Society for Burn Injury, the Society for Critical Care Medicine, the European Burns Association and the British Burn Association to collaborate in a Surviving Burn Injury Campaign (SBIC) with the lofty goal of achieving a significant reduction in burn injury morbidity and mortality by 2030?

Conclusion (proposition de traduction) : Enfin, nous saluons les auteurs pour leur précieuse contribution aux soins de cette malheureuse population de patients. Il est peut-être temps maintenant pour les nombreuses sociétés et institutions, notamment la Société française d'anesthésie et de médecine intensive, l'Australian and New Zealand Burn Association, l'Australian and New Zealand Intensive Care Society, l'International Society for Burn Injury, la Society for Critical Care Medicine, l'European Burns Association et la British Burn Association pour collaborer à une campagne Surviving Burn Injury Campaign (SBIC) avec l'objectif ambitieux de parvenir à une réduction significative de la morbidité et de la mortalité par brûlure d'ici 2030 ?

Commentaire : Document de référence :
Société Francophone de Brûlologie, Société Française de Médecine d'Urgence & Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française. Prise en charge du brûlé grave à la phase aiguë chez l’adulte et l’enfant  . Recommandations de Pratiques Professionnelles. Société Française d’Anesthésie et Réanimation (SFAR) mai 2019.

Efficacy and Safety of Remifentanil in a Rapid Sequence Induction in Elderly Patients: A Three-Arm Parallel, Double Blind, Randomised Controlled Trial.
Chaumeron A, Castanie J, Fortier LP, Basset P, Bastide S, Alonso S, Lefrant JY, Cuvillon P. | Anaesth Crit Care Pain Med.  2020 Apr;39(2):215-220
DOI: https://doi.org/10.1016/j.accpm.2019.09.010
Keywords: Adverse event; Heart rate; Induction; Rapid sequence; Remifentanil.

Original article

Introduction : Rapid sequence induction (RSI) is recommended in patients at risk of aspiration, but induced haemodynamic adverse events, including tachycardia. In elderly patients, this trial aimed to assess the impact of the addition of remifentanil during RSI on the occurrence of: tachycardia (primary outcome), hypertension (due to intubation) nor hypotension (remifentanil).

Méthode : In this three-arm parallel, double blind, multicentre controlled study, elderly patients (65 to 90 years old) hospitalised in three centres and requiring RSI were randomly allocated to three groups, where anaesthesia was induced with etomidate (0.3 mg/kg) followed within 15 seconds by either placebo, or low (0.5 μg/kg), or high (1.0 μg/kg) doses of remifentanil, followed by succinylcholine 1.0 mg/kg. Heart rate (HR) and mean arterial pressure (MAP) were recorded before induction and after intubation.

Résultats : In total, eighty patients were randomised and analysed. Baseline HR and MAP were similar between groups. For primary endpoint, the absolute change in HR between induction and intubation was greater in the control group (15 bpm; 95% CI [8-21]) than that in the remifentanil 0.5 μg/kg group (4 bpm; 95% CI [-1-+8]; P=0.005) and the remifentanil 1.0 μg/kg group (-3 bpm; 95% CI [-9-+3]; P<0.0001). The increase in MAP was greater in the placebo group than in both remifentanil groups (P<0.0001). Twice as many hypertension episodes were recorded in the placebo group compared to the remifentanil 0.5 μg/kg and 1.0 μg/kg groups (60%, 30%, and 28% patients respectively; P=0.032), but no placebo patients experienced hypotension episodes versus 11% and 24% in the remifentanil 0.5 μg/kg and 1.0 μg/kg groups respectively (P=0.016).

Conclusion : Remifentanil (0.5-1.0μg/kg) prevents the occurrence of tachycardia and hypertension in elderly patients requiring RSI.

Conclusion (proposition de traduction) : Le rémifentanil (0,5-1,0 μg/kg) prévient la survenue d'une tachycardie et d'une hypertension chez les patients âgés nécessitant une induction en séquence rapide.

Annals of Emergency Medicine

Implementation of Evidence-Based Practice for Benign Paroxysmal Positional Vertigo in the Emergency Department: A Stepped-Wedge Randomized Trial.
Kerber KA, Damschroder L, McLaughlin T, Brown DL, Burke JF, Telian SA, Tsodikov A, Fagerlin A, An LC, Morgenstern LB, Forman J, Vijan S, Rowell B, Meurer WJ. | Ann Emerg Med.  2020 Apr;75(4):459-470
DOI: https://doi.org/10.1016/j.annemergmed.2019.09.017  | Télécharger l'article au format  
Keywords: Aucun

Neurology

Introduction : We evaluated a strategy to increase use of the test (Dix-Hallpike's test [DHT]) and treatment (canalith repositioning maneuver [CRM]) for benign paroxysmal positional vertigo in emergency department (ED) dizziness visits.

Méthode : We conducted a stepped-wedge randomized trial in 6 EDs. The population was visits with dizziness as a principal reason for the visit. The intervention included educational sessions and decision aid materials. Outcomes were DHT or CRM documentation (primary), head computed tomography (CT) use, length of stay, admission, and 90-day stroke events. The analysis was multilevel