[Ballistic wound in the pre-hospital and emergency room: Damage Control Resuscitation]

Damage Control Resuscitation (DCR) is a strategy designed to prioritize hemostasis procedures, from the point of injury to surgical management, whether faced with an influx of bleeding casualties or a single casualty with severe hemodynamic instability. Widely disseminated, it provides clear objectives for prioritizing physiological restoration to the anatomy required for short-term survival. Initially applied to surgery, DCR has now been extended to the entire upstream care chain, including first aid and emergency medicine.

[War wounds in the operating theatre: Damage Control Surgery]

In the course of conflicts, the management of severe trauma patients in the operating room has led to the development of surgical and resuscitation techniques that ensure the survival of as many patients as possible. These techniques are based on the principles of Damage Control (DC) by a single, trained team. In this article, we look at the fundamentals of DC, followed by its application in each surgical field. The question of team training is at the heart of this approach.

[Dealing with the bleeding patient, being effective with (almost) nothing]

The practice of pre-hospital care, whether you are a professional rescuer, a nurse, a doctor or a simple citizen, sometimes exposes you to the management of a patient who presents an acute hemorrhage. The prognosis is quickly life-threatening if the safety, assessment, life-saving gestures and activation of the rescue chain are not carried out. A basic, inexpensive first aid kit can further reduce morbidity and mortality. Training first responders in life-saving techniques is a public health issue.

[Bleeding management in the operating theatre]

Despite all the measures taken preoperatively, bleeding may persist and require surgical control. Before considering treatment, it is necessary to establish the diagnosis with the origin of the bleeding. The surgical procedure depends on the aetiology. There are many surgical options and adjuvant measures to consider. They should be known by the operating theatre nurse, who is a major player in surgical management. Successful control of bleeding requires quality multidisciplinary collaboration.

[The lethal triad of hemorrhage]

Coagulopathy, acidosis and hypothermia form the lethal triad in trauma patients with acute hemorrhage. The prevention of this chain reaction relies on an adapted management from the first care in pre-hospital situation: rapid arrest of bleeding, fight against hypothermia, limited vascular filling with an early recourse to vasoactive amines. Pre-hospital transfusion is still rare, whereas in the hospital, an adapted transfusion strategy can wait for or support a surgical or radiological hemostasis procedure.

[Procoagulant hemostatic dressings and hemorrhages]

When faced with a hemorrhage, there are many ways to achieve hemostasis. War medicine and terrorist attacks have taught us the wide use of the tactical tourniquet since hemorrhagic injury is the leading cause of death, mainly in pre-hospital care. The existence of hemorrhagic areas not accessible to tourniquets and the possibility of conversion of a tourniquet by other non-ischemic local hemostasis means have demonstrated the relevance of compression by internal or external packing. Procoagulant hemostatic dressings have progressed in their efficacy over four generations. History and development.

[Management of patients with haemorrhage malignant wounds]

Patients with tumor wounds have many symptoms that impair their quality of life and their general condition. Hemorrhaging is one of them. It can be a challenge for the caregivers and the medical team and will have an impact on the patient. There is no consensus on the management of this symptom, but the literature provides some food for thought. Simple measures can be easily implemented depending on the patient's risk factors, the wound and the oncological context.

[The ABC's of the tactical tourniquet]

Uncontrolled bleeding is the leading cause of preventable death. After rapid diagnosis of the injury, early stoppage of the bleeding and maintenance of effective coagulation are, in the pre-hospital setting, the two mainstays of treatment of hemorrhagic shock. The latter requires a trained and experienced medical and paramedical team to prevent patient morbidity and mortality.

[Understanding haemostasis to improve its management]

Haemostasis represents all the complex and interdependent mechanisms which enable bleeding to stop. This process involves the vessel walls, platelets, coagulation factors and von Willebrand factor. In the event of a disorder, the specific characterisation of the condition is the first stage of the diagnosis. Treatment is mainly based on substitution. All these disorders and their complications require multidisciplinary and specialised care.

[Role of the nurse in the case of complex hand wounds]

The initial assessment and care determine the quality of the secondary surgical treatment of complex hand wounds. The caregiver providing this initial care plays a critical role. The analysis of the management of these traumas in exceptional situations enables the key stages of the initial treatment to be identified: bleeding control, infection prevention and an accurate assessment of the injury. These measures thereby help to optimise the patient's transfer towards a specialised unit.

[The Multimorbid Patient: Use of New Oral Anticoagulants in Patients with Chronic Kidney Disease]

The Multimorbid Patient: Use of New Oral Anticoagulants in Patients with Chronic Kidney Disease Abstract. Increasing life expectancy in Western countries is associated with a high prevalence of multiple chronic diseases which is defined by the term "multimorbidity". Many of these patients suffer from chronic kidney disease (CKD) and thrombogenic comorbidities such as atrial fibrillation with the need for oral anticoagulation. For decades vitamin K antagonists have been exclusively prescribed for oral anticoagulation. However, due to altered pharmacokinetics and bioavailability of these drugs in CKD, a significant risk of bleeding exists. The introduction of direct oral anticoagulants as a new and promising alternative to vitamin K antagonists was -especially for CKD patients - highly anticipated. However, data from randomized studies are missing for older patients with advanced CKD. Consequently, a careful evaluation of the risk-benefit ratio is recommended for this sensitive patient population.

[Diseases as a 'Stumbling Block' - a Case of Multimorbidity in Clinical Practice]

Diseases as a `Stumbling Block` - a Case of Multimorbidity in Clinical Practice Abstract. Here we report on a 83 year-old patient with cardiac syncope and consecutive traumatic brain injury with intracranial haemorrhage receiving anticoagulation for recurrent pulmonary embolism: a 'medical dilemma' due to the syncope with consecutive traumatic event and the underlying condition. A pre-existing underlying cardiac disease was identified as the cause of the syncope and the intracranial haemorrhage was most likely due to oral anticoagulation for recurrent pulmonary embolisms. The intracranial bleeding inhibited an optimal management of the underlying cardiac condition and the patient deceased shortly thereafter.

[Not Available]

We report the case of a severe burn patient who presented an asystole during a dermo-epidermal graft of the two upper limbs. Perioperative bleeding, hypovolemia and hypothermia are at the origin of this incident. We review the management of cardiopulmonary arrest in the operating theatre during burns surgery.

[Management of failures and complications in weight loss surgery]

The specific management of the surgical risks linked to obesity, as well as technological advances combined with the standardisation of techniques, have significantly reduced the morbidity and mortality associated with bariatric surgery over recent decades. However, as with all surgery, patients are exposed to medical and surgical failures and complications.

Controlled reperfusion for different durations in the treatment of ischemia-reperfusion injury of the rat ovary: evaluation of biochemical features, molecular gene expression, and histopathology

High numbers of proinflammatory cells (PMNLs), which are carried by the blood to ischemic tissue during reperfusion, are considered responsible for inducing the inflammatory response that occurs in ischemia-reperfusion (I/R) injury. Our objective was to determine the controlled reperfusion (CR) interval duration (CRID) that would minimize the injury caused by the PMNLs that infiltrate ischemic tissue. Animal groups were divided into the following groups: Sham group, ovarian I/R group (OIR), and ovarian ischemia controlled-reperfusion groups OICR-1, OICR-2, OICR-3, OICR-4, OICR-5, OICR-6, which had their ovarian artery opened and then closed for 10, 8, 6, 4, 2, or 1 s, respectively. The results show that the COX-2 activity and the gene expression decreased while the COX-1 activity and the gene expression were found to be increased in parallel to the shortening of the period in CRID. From the histopathological examinations, the findings of hemorrhage, edema, congested vascular structures, degenerated cells, and migration and adhesion of PMNLs were scaled as follows: Sham group < OICR-6 < OICR-5 < OICR-4 < OICR-3 < OICR-2 < OICR-1. The results from the histopathological assessments were consistent with the molecular and biochemical findings. In conclusion, our findings suggest that increased COX-2 activity plays a role in I/R injury of the rat ovary, and that controlled reperfusion for 3, 2, or 1 s following 2 h of ischemia may attenuate the effects of I/R injury.

[Amniotic fluid embolism: report of two cases]

L’embolie de liquide amniotique (ELA) est une complication imprévisible de l’accouchement, souvent fatale, associant un collapsus cardiovasculaire sévère, un syndrome de détresse respiratoire aiguë et une hémorragie avec coagulation intra vasculaire disséminée (CIVD). Dès l’évocation du diagnostic, la prise en charge doit être multidisciplinaire et intensive. ELA est responsable d’une mortalité maternelle et néonatale importante, son incidence est extrêmement variable selon les études et le taux de mortalité maternelle varie entre 26 et 86 % selon les études. Ces dix dernières années, le pronostic materno-fœtal semble en amélioration grâce aux progrès de prise en charge standardisée multidisciplinaire sur les lieux d’accouchement. Nous rapportons deux cas d’embolie de liquide amniotique. Le premier cas s’est manifesté au cours du travail et le deuxième cas est survenu dans les suites immédiates de l’accouchement.

[Accidents to AVK: a retrospective study of 30 cases]

Les accidents hémorragiques sous AVK (antivitamines K) sont la première cause d’hospitalisation iatrogène. Le but de cette étude est de ressortir les caractéristiques des patients présentant des accidents hémorragiques graves sous AVK et de mettre le point sur la prise en charge. Nous avons réalisé une étude rétrospective portant sur 30 malades, réalisée au service de réanimation de l’hôpital militaire Avicenne de Marrakech. L’âge moyen de nos patients est de 59, 6 avec un sexe ratio de 1,5 (18 femmes et 12 femmes). On note dans notre série le terrain multi-taré des patients sous AVK avec plusieurs antécédents en cause. La fibrillation auriculaire était la principale indication recensée. Plus que la moitié ne bénéficiaient pas d’une bonne surveillance biologique à base d’INR (international normalized ratio). Le saignement d’origine gastro-intestinal était le plus fréquent. La conduite était différente en fonction des cas mais axée sur l’arrêt des AVK, l’administration de vit K, la transfusion de culots globulaires et plasma frais congelé. Plus du quart des patients admis sont décédés. L’index de Landefeld s’est avéré utile, il permet de classer les patients selon le risque prédictif de saignement (élevé moyen ou faible), ce qui concordait avec les résultats de notre étude. Son importance est d’ autant plus qu’il est facile à mesurer et à appliquer par le médecin en ambulatoire et permet de définir les patients nécessitant une surveillance accrue. La polymédication et les antécédents de saignement digestif sont apparus comme facteur de risque de saignement sous AVK. La prévention de la survenue de ces accidents est le pilier de la prise en charge, d’où l’importance de l’information et de l’éducation des différents intervenants dans cette complication iatrogène potentiellement mortelle.