Parlant de combitube Jocelyn, j'ai cherché de la documentation sur le temps qu'il était sûr de le laisser en place et n'ai rien trouvé . Les meilleures réponses étant il va de soi pas plus longtemps qu'il ne faut et le moins longtemps possible évidemment.
MCk --- [EMAIL PROTECTED] a écrit : > > Attention, il faut comparer des pommes avec des > pommes, nos voisins du sud > font de l'intubation endo trachéale alors que nos > paramédics utilisent des > Combitubes. Cet article n'a donc aucune valeur dans > ce contexte. > > Cela n'enlève pas cependant la nécessité de > vérifier le A et le B, mais cela > demeure vrai dans toutes circonstances. > > JM > > In a message dated 2007-06-18 03:53:59 Est (heure > d'été), > [EMAIL PROTECTED] writes: > > > Je suis sur que nos super paramedics sont mieux > entraines que nos voisins du > sud... :) > Mais avec cette etdue, il y a de quoi nous pousser > encore plus a ne pas > hesiter a verifier le A et B lors d'une arrivee d'un > patient intubate > > Summary and Comment > Adult Prehospital Intubation: More Harm Than Good? > One quarter of intubated patients had unrecognized, > misplaced endotracheal > tubes in a study from the New York City emergency > medical system. > > Recent pediatric studies in emergency medical > systems with short transport > times suggest that prehospital intubation provides > no benefit or is even > potentially harmful, compared with ventilation > alone. In a prospective > observational study, researchers assessed the > frequency of unrecognized esophageal > intubation in 132 consecutive adult patients who > were transported to two New York > City emergency departments and had been intubated in > the field. Emergency > physicians confirmed tube placement by direct > visualization (71%), end-tidal > carbon dioxide detection (39%), or both. Tubes were > misplaced in 32 patients > (24%), with 20 tubes in the right mainstem bronchus, > 11 in the esophagus, and 1 > in the hypopharynx. Only one patient with a > prehospital esophageal intubation > survived to hospital discharge. Information was not > available on the > training and experience of the paramedics who > performed all prehospital intubations. > The researchers assessed reasons for deferred > intubation in a separate group > of 60 consecutive patients who were intubated within > 10 minutes after > arrival at the same hospitals. Prehospital > intubation was not attempted in 52% and > was unsuccessful in 22%. The most common reasons for > not attempting > prehospital intubation were short transport time and > suspected difficult airway. The > authors call for controlled trials to assess whether > prehospital intubation of > adult patients improves outcomes. > Comment: Adult prehospital endotracheal intubation > is yet another example of > a protocol that was implemented without prior > scientific validation of > outcomes benefit. Now that this procedure is > standard care, controlled trials > would be difficult to design and might face > challenges from research ethics > boards. However, the high rate of tube misplacement > found in this study â > consistent with rates reported in other systems â > is unacceptable. The key > prehospital intervention is oxygenation, not > necessarily intubation; other airway > management methods, such as use of laryngeal mask > airways, may be preferable to > intubation. Prehospital intubation requires > mandatory confirmation of proper > tube placement by end-tidal carbon dioxide > monitoring, which often was not done > in this study. EPs must immediately confirm proper > tube placement for all > patients who have been intubated in the field. > â _Kristi L. Koenig, MD, FACEP_ > (http://emergency-medicine.jwatch.org/misc/board_about.dtl#aKoenig) > > Published in Journal Watch Emergency Medicine June > 15, 2007 > Citation(s): > Wirtz DD et al. Unrecognized misplacement of > endotracheal tubes by ground > prehospital providers. Prehosp Emerg Care 2007 > Apr-Jun; 11:213-8. > > > > ____________________________________ > Take the Internet to Go: Yahoo!Go puts the _Internet > in your pocket:_ > (http://us.rd.yahoo.com/evt=48253/*http://mobile.yahoo.com/go?refer=1GNXIC) > mail, > news, photos & more. > > > > > > > > Découvrez ce qui fait jaser les gens ! Visitez les groupes de l'heure sur Yahoo! Québec Groupes. http://cf.groups.yahoo.com/ --- URG-L Les archives de la liste d'echange sont disponibles pour consultation a l'adresse : <http://webmail.niveau3.ca/public/mail-archives/[email protected]>. L'acces est protege par mot de passe: usager: archives et mot de passe: archives Les archives antérieures sont disponibles a : <http://www.mail-archive.com/[email protected]>
