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Toute crise d’asthme aigu grave (CAAG) impose une prise en charge médicale préhospitalière spécialisée par un Smur.
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En dehors des critères cliniques, la gravité d’une CAAG repose avant tout sur ...l’existence d’un débit expiratoire de pointe (DEP, ou peak-flow) inférieur à 30 % de la valeur prédite par abaque ou de la valeur de référence du patient.
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Le traitement initial associe des nébulisations continues de bêta2-mimétiques et de bromure d’ipratropium, sous oxygène, et une injection de corticoïdes.
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Devant une crise réfractaire, sont recommandés en deuxième intention le sulfate de magnésium, les bêta2-mimétiques en perfusion au pousse-seringue électrique, ou de préférence l’adrénaline en cas de choc associé.
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En cas de recours à la ventilation mécanique, il faut utiliser de petits volumes courants, une fréquence basse et prolonger le temps expiratoire.
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Any life-threatening episode of asthma requires early pre-hospital specialized medical management by emergency medical crews.
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Gravity depends on both clinical criteria and a peak expiratory flow rate (PEFR) more than 30% below either the level predicted by the reference graph or the patient's reference value.
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Initial treatment combines continuous nebulizations containing a beta2-agonist and ipratropium bromide, with oxygen administration and intravenous corticosteroid bolus.
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Recommended as second-line treatment in the absence of adequate response are: intravenous magnesium sulphate and continuous-perfusion beta2-agonists (electric syringe), or, in the case of shock, epinephrine.
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If mechanical ventilation is required its settings should aim for low tidal volumes, low frequency, and increased expiratory time.
Steadily increasing since 1990, the use of psychoactive substances was expanded to new designer drugs (bath salts, spice) with so original still unknown pharmacological effects. At the beginning, the ...pleasure, first feeling, turns sometimes, in acute medical emergency and then, in some cases, in chronic diseases. Side expected or not desired effects, seen in emergency departments could be necrotizing gangrene among consumers Krokodil or dystonic reactions in consumers of Spice. Moreover, adulterants could increase the dangerosity of the substances. Searching a toxidrome helps to find the incrimining substance.
Beta-blocker intoxication Joye, F
La Presse médicale (1983),
2000-May-20, Letnik:
29, Številka:
18
Journal Article
Recenzirano
Beta-blocker intoxication is not frequent but can produce particularly severe or fatal conditions which must not be underestimated. Severity of beta-blocker intoxication varies from one compound to ...another. The more toxic drugs are propranolol, sotalol, oxprenolol, metoprolol, atenolol, acebutolol, labetalol, and carvedilol. Besides the drug type, history taking can provide a precise assessment of risk, particularly important in when elderly patients with a cardiovascular history have taken more than 20 tablets, when emergency care is provided late, and when other cardiotoxic or psychotoxic drugs have been coingested.
The diagnosis of beta-blocker intoxication must be suspected in any case associating hypotension and bradycardia. The main cardiovascular complications are cardiogenic shock, atrio-ventricular conduction disorders, and obviously life-threatening ventricular arrhythmia with cardiac arrest. Centrally induced respiratory arrest is a rare but dreadful consequence which can occur suddenly even without hemodynamic failure. Neurologic toxicity is mainly expressed by consciousness disorders and more sporadically by seizures. Laboratory tests show variable serum potassium, lactic acidosis, hypoxia-hypercapnia resulting from hypoventilation, and rarely hypoglycemia. The ECG should be recorded early because electrocardiographic signs usually appear before clinical signs and QRS enlargement is a factor predictive of severe ventricular arrhythmia.
The patient must be placed in an intensive care unit for continuous multiparametric monitoring. Besides gastric evacuation and symptomatic measures, treatment essentially requires glucagon for its positive inotropic effect after high intravenous doses. If glucagon infusion is ineffective or unavailable, an alternative would be to use high doses of vasoactive agents, choosing isoproterenol or epinephrine as the first intention drugs.
Contrôle ultime de Beth-Vincent : un test trop bien maîtrisé ? Joye, F.; Rousse-Lussac, C.; Llari, F. ...
Transfusion clinique et biologique : journal de la Société française de transfusion sanguine,
12/2010, Letnik:
17, Številka:
5
Journal Article
Infection of Hydrilla verticillata by Macrophomina phaseolina was investigated using scanning and transmission electron microscopy. Sprigs of plants in petri plates were inoculated with suspensions ...of fungal hyphae. Samples of inoculated and noninoculated plants were taken over time. Fungal cells attached to lower epidermal cell walls but not the upper epidermal cell walls of leaves. In less than 40 h, penetration through the cell wall was completed and colonization of host cells was observed. Penetration of upper epidermis was limited to the cell wall adjacent to a lower epidermal cell. No penetration was observed through the outer cell wall of upper epidermis. Inhibition of penetration through the outer cell wall of the upper epidermis may be attributable to an osmiophilic layer below the cell wall. Disruption of the host cell walls and subsequent host cell death was preceded by massive colonization of the host by this pathogen.
Any life-threatening episode of asthma requires early pre-hospital specialized medical management by emergency medical crews. Gravity depends on both clinical criteria and a peak expiratory flow rate ...(PEFR) more than 30% below either the level predicted by the reference graph or the patient's reference value. Initial treatment combines continuous nebulizations containing a beta2-agonist and ipratropium bromide, with oxygen administration and intravenous corticosteroid bolus. Recommended as second-line treatment in the absence of adequate response are: intravenous magnesium sulphate and continuous-perfusion beta2-agonists (electric syringe), or, in the case of shock, epinephrine. If mechanical ventilation is required, its settings should aim for low tidal volumes, low frequency, and increased expiratory time.
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