Hôpital-Camfrout, France
Hôpital-Camfrout, France

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Bounes V.,Hopital University Of Purpan | Bounes V.,French Institute of Health and Medical Research | Valle B.,Hopital University Of Purpan | Concina F.,Hopital University Of Purpan | And 3 more authors.
American Journal of Emergency Medicine | Year: 2016

Objectives To assess the prescribing patterns in acute renal colic in emergency departments in US and France, by comparing physicians’ intended prescription practices with actual prescription data in a sample of emergency practitioners. Methods Pharmaco-epidemiological international study in two phases. First, we surveyed emergency physicians in US and France as to what analgesics they would use for simulated cases of renal colic. We then conducted a retrospective review of actual cases of emergency department patients with pain scores ≥6/10 with acute renal colic during a period of 6 months before the survey. We compared nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids used for pain treatment in the two groups, and the differences between the two countries. Results One hundred six prescribers and 100 patients were included in the study. Comparison between simulated and real cases showed that NSAIDs and opioids were less frequently prescribed in real life (78% vs 99% and 51% vs 100% respectively). Morphine was the most prescribed opioid (96% of simulated cases and 34% of real ones). Acetaminophen use was increased in real life cases (58% vs 0%). Concerning the differences between countries, US physicians are more likely to administer morphine (64% vs 38%) and French physicians NSAIDs (88% vs 68%). The NSAIDs used are ketorolac in the United States (94% of simulated cases vs 64%) and ketoprofen in France (94% and 88% respectively). Discussion We showed clear differences between intended and real analgesic prescription practices for patients suffering from renal colic. Some differences exist for pain perceptions and treatments between US and France. © 2016


Durand-Bechu M.,Hopital University Of Purpan | Chaminade B.,Hopital University Of Rangueil | Belleudy P.,Federation francaise de montagne et descalade FFME | Gasq D.,Hopital University Of Rangueil
Science and Sports | Year: 2014

Objectives: To describe rock-climbing injuries in France between 2004 and 2011. Patients and methods: Retrospective epidemiological study of reported rock-climbing accidents identified by the French Federation of Mountain and Climbing sports from 2004 until 2011. This included all licensed holders registered with the Federation and climbing in natural outdoor sites as well as indoor sites. Results are expressed in number, percentage and number of injuries for 1000. hours of practice. Results: One thousand one hundred and twenty-eight accidents were identified, with a 1.49 average rate of injury in 1000. hours of practice. Female climbers accounted for 0.35% injured per year, while the percentage was lower for men (0.27%). Climbers who had an accident were aged from 6 to 75. Climbers aged from 19 to 30 experienced the highest rate of injuries, 0.37% per year. The most common injuries were fractures and dislocations (respectively 39% and 25% for men, and 30% and 34% for women). Conclusion: The low incidence of traumatic injuries during rock-climbing brings into question the relevance of the classification used to rank high-risk sports. This, however, is no reason to stop strengthening prevention so that the number and serious accidental injuries may be reduced. © 2014 Elsevier Masson SAS.


PubMed | Institut Universitaire de France, Toulouse University Hospital Center, Hopital University Of Purpan and University Paris Diderot
Type: | Journal: Case reports in emergency medicine | Year: 2016

Systemic Capillary Leak Syndrome (SCLS) is a rare disease with poor prognosis, characterized by the occurrence of mucocutaneous and visceral edema with hypotension, hemoconcentration, and unexpected hypoalbuminemia. The disease can be idiopathic (Clarkson syndrome) or secondary to other diseases and treatments. We describe this syndrome in a prehospitalized, 63-year-old patient with chronic lymphocytic leukemia and an idiopathic form of SCLS manifesting as hypovolemic shock. Initial care is hospitalization in intensive care. In addition to etiological treatment if fluid replacement is necessary, treatment must be closely monitored for secondary overload complications. Catecholamine rather than arrhythmogenic support may be associated.


Ducasse J.-L.,Hopital University Of Purpan | Siksik G.,Service de Sante et de Secours Medical SSSM | Durand-Bechu M.,Hopital University Of Purpan | Couarraze S.,Service de Sante et de Secours Medical SSSM | And 5 more authors.
Academic Emergency Medicine | Year: 2013

Objectives Although 50% nitrous oxide (N2O) and oxygen is a widely used treatment, its efficacy had never been evaluated in the prehospital setting. The objective of this study was to demonstrate the efficacy of premixed N2O and oxygen in patients with out-of-hospital moderate traumatic acute pain. Methods This prospective, randomized, multicenter, double-blind trial enrolled patients with acute moderate pain (numeric rating scale [NRS] score between 4 and 6 out of 10) caused by trauma. Patients were assigned to receive either 50/50 N2O and oxygen 9 L/min (N2O group) or medical air (MA) 9 L/min (MA group), in ambulances from two nurse-staffed fire department centers. After the first 15 minutes, every patient received N 2O and oxygen. The primary endpoint was pain relief at 15 minutes (T15), defined as a NRS ≤ 3 of 10. The NRS was measured every 5 minutes. Secondary endpoints were treatment safety and adverse events, time to analgesia, and patient and investigator satisfaction with analgesia. Results Sixty patients were included with no differences between groups in age (median = 34 years, interquartile range [IQR] = 23 to 53 years), sex (37 males, 66%), and initial median NRS of 6 (IQR = 5 to 6). At T15, 67% of the patients in the N2O group had an NRS score of 3 or lower versus 27% of those in the MA group (delta = 40%, 95% confidence interval [CI] = 17% to 63%; p < 0.001). The median pain scores were lower in the N2O group at T15, 2 (IQR = 1 to 4) versus 5 (IQR = 3 to 6). There was a difference at 5 minutes that persisted at all subsequent time points. Four patients (one in the N 2O group) experienced adverse events (nausea) during the protocol. Conclusions This study demonstrates the efficacy of N2O for the treatment of pain from acute trauma in adults in the prehospital setting. © 2013 by the Society for Academic Emergency Medicine.

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