ELISA : ECHELLE LIÉGEOISE DE L’INDICE DE SÉVÉRITÉ À L’ADMISSION

in Revue Médicale de Liège (2012), 67(12), 632-637

Les services d’urgence sont régulièrement confrontés au problème d’encombrement à l’admission par une demande qui dépasse l’offre de soins. Il est essentiel de réguler le flux d’entrée par la mise en ... [more ▼]

Les services d’urgence sont régulièrement confrontés au problème d’encombrement à l’admission par une demande qui dépasse l’offre de soins. Il est essentiel de réguler le flux d’entrée par la mise en place d’un dispositif de tri. Ce mécanisme s’affine depuis une quinzaine d’années. Nous proposons un algorithme de tri (ELISA ou Echelle Liégeoise de l’Indice de Sévérité à l’Admission) qui vise à définir l’état d’urgence selon 5 niveaux depuis la catégorie U1 (urgence absolue) à U5 (urgence relative). Ces niveaux sont associés à un délai de contact médical (immédiat à 120 minutes) et à un trajet de soin correspondant (salle de déchoquage, secteur B ou brancard, secteur A ou ambulatoire, salle d’attente) réunissant ainsi des impératifs de temps et de lieu de prise en charge optimaux. Notre algorithme de tri montre une excellente fiabilité par la comparaison du niveau initial de la catégorisation au devenir du patient (soins intensifs, hospitalisation, et sortie du service). [less ▲]

Arterial dP/dtmax accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved

in BMC Cardiovascular Disorders (2012), 12:13

Background: Peak first derivative of femoral artery pressure (arterial dP/dt max) derived from fluid-filled catheter remains questionable to assess left ventricular (LV) contractility during shock. The ... [more ▼]

Background: Peak first derivative of femoral artery pressure (arterial dP/dt max) derived from fluid-filled catheter remains questionable to assess left ventricular (LV) contractility during shock. The aim of this study was to test if arterial dP/dt maxis reliable for assessing LV contractility during various hemodynamic conditions such as endotoxin-induced shock and catecholamine infusion.Methods: Ventricular pressure-volume data obtained with a conductance catheter and invasive arterial pressure obtained with a fluid-filled catheter were continuously recorded in 6 anaesthetized and mechanically ventilated pigs. After a stabilization period, endotoxin was infused to induce shock. Catecholamines were transiently administrated during shock. Arterial dP/dt maxwas compared to end-systolic elastance (Ees), the gold standard method for assessing LV contractility.Results: Endotoxin-induced shock and catecholamine infusion lead to significant variations in LV contractility. Overall, significant correlation (r = 0.51; p < 0.001) but low agreement between the two methods were observed. However, a far better correlation with a good agreement were observed when positive-pressure ventilation induced an arterial pulse pressure variation (PPV) ≤ 11% (r = 0.77; p < 0.001).Conclusion: While arterial dP/dt maxand Ees were significantly correlated during various hemodynamic conditions, arterial dP/dt maxwas more accurate for assessing LV contractility when adequate vascular filling, defined as PPV ≤ 11%, was achieved. © 2012 Morimont et al; licensee BioMed Central Ltd. [less ▲]

Acute pericarditis associated with acquired toxoplasmosis in an immunocompetent patient

Poster (2012)

Providing emergency medical care in a National football League stadium : analysis of patient load data

Poster (2012)

Mathematical multi-scale model of the cardiovascular system including mitral valve dynamics. Application to ischemic mitral insufficiency

in BioMedical Engineering OnLine (2011), 10(1), 86

Valve dysfunction is a common cardiovascular pathology. Despite significant clinical research, there is little formal study of how valve dysfunction affects overall circulatory dynamics. Validated models ... [more ▼]

Valve dysfunction is a common cardiovascular pathology. Despite significant clinical research, there is little formal study of how valve dysfunction affects overall circulatory dynamics. Validated models would offer the ability to better understand these dynamics and thus optimize diagnosis, as well as surgical and other interventions. A cardiovascular and circulatory system (CVS) model has already been validated in silico, and in several animal model studies. It accounts for valve dynamics using Heaviside functions to simulate a physiologically accurate “open on pressure, close on flow” law. However, it does not consider real-time valve opening dynamics and therefore does not fully capture valve dysfunction, particularly where the dysfunction involves partial closure. This research describes an updated version of this previous closed-loop CVS model that includes the progressive opening of the mitral valve, and is defined over the full cardiac cycle. Simulations of the cardiovascular system with healthy mitral valve are performed, and, the global hemodynamic behaviour is studied compared with previously validated results. The error between resulting pressure-volume (PV) loops of already validated CVS model and the new CVS model that includes the progressive opening of the mitral valve is assessed and remains within typical measurement error and variability. Simulations of ischemic mitral insufficiency are also performed. Pressure-Volume loops, transmitral flow evolution and mitral valve aperture area evolution follow reported measurements in shape, amplitude and trends. The resulting cardiovascular system model including mitral valve dynamics provides a foundation for clinical validation and the study of valvular dysfunction in vivo. The overall models and results could readily be generalised to other cardiac valves. [less ▲]

L'image du mois : fracture disco-ligamentaire variante de la fracture de chance

in Revue Médicale de Liège (2011), 66(7-8), 409-10

L'image du mois : occlusion grêle sur hernie abdominale interne au travers de l'hiatus de Winslow

in Revue Médicale de Liège (2011), 66(9), 464-65

Dispatcher-assisted telephone cardiopulmonary resuscitation using a French-language compression-only protocol in volunteers with or without prior life support training: A randomized trial.

in Resuscitation (2011)

OBJECTIVES: Due to the recent interest in hands-only protocols for dispatcher-assisted cardiopulmonary resuscitation (CPR) and the lack of any validated algorithms in French, our primary objective was to ... [more ▼]

OBJECTIVES: Due to the recent interest in hands-only protocols for dispatcher-assisted cardiopulmonary resuscitation (CPR) and the lack of any validated algorithms in French, our primary objective was to evaluate a new French-language protocol in terms of its efficacy to help previously untrained volunteers in performing basic life support efforts of appropriate quality, and secondarily to investigate its potential utility in subjects with previous training. METHODS: Untrained volunteers were recruited among adults in a public movie centre and previously trained volunteers among undergraduate nursing students. Participants were randomly assigned to 'phone CPR' versus 'no phone CPR' by drawing sets of envelopes. Primary outcome measures were the results of the Cardiff evaluation test; the secondary measures were global scoring of a complete 5min period of CPR, in a manikin model of cardiac arrest. RESULTS: Out of 146 volunteers assessed for eligibility, 36 previously untrained candidates declined participation. 110 participants, distributed into four groups, completed the study: the previously untrained non-guided group (group A, n=30), the previously untrained guided group (group B, n=30), the previously trained non-guided group (group C, n=25) and the previously trained guided group (group D, n=25). Results of the Cardiff test and global evaluation of CPR performance revealed a significant improvement in group B as compared with group A, approaching the level of the group C. Previously trained guided bystanders had the best CPR scores, notably because of an improvement in the quality of airway management. CONCLUSION: When used by dispatchers, this new French-language algorithm offers the opportunity to help previously untrained bystanders initiate CPR. The same protocol may serve to guide volunteers with prior basic life support training to reach their best CPR performance. [less ▲]

Hemolytic uremic syndrome with an atypical presentation.

in Revue Médicale de Liège (2010), 65(12), 676-80

RÉ SUMÉ : Le syndrome hémolytique urémique (SHU ) est une affection assez rare chez l’adulte, mais de pronostic réservé. Il traduit une microangiopathie thrombotique essentiellement rénale. Nous ... [more ▼]

RÉ SUMÉ : Le syndrome hémolytique urémique (SHU ) est une affection assez rare chez l’adulte, mais de pronostic réservé. Il traduit une microangiopathie thrombotique essentiellement rénale. Nous rapportons l’histoire d’un jeune patient dont la présentation et l’exploration cliniques rendent le diagnostic de SHU probable. La présentation quelque peu atypique offre non seulement l’occasion de discuter des différents éléments qui plaident en faveur du diagnostic selon les hypothèses physiopathologiques les plus récentes, mais aussi de redéfinir les recommandations de la prise en charge en urgence de cette affection sévère. [less ▲]

Dispatcher-assisted telephone cardiopulmonary resuscitation using a french compression-only protocol: performance of volunteers with or without prior life support training

in Critical Care: the Official Journal of the Critical Care Forum (2010), 14(suppl1)