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Background: A relative hypovolemia occurs during septic shock (SS); the early phase is clinically reflected by tachycardia and low blood pressure. In the prehospital setting, simple objective tools to assess hypovolemia severity are needed to optimize triaging., Objective: The aim of this study was to evaluate the relationship between shock index (SI), diastolic SI (DSI), modified SI (MSI), and age SI (ASI) and 28-day mortality of patients with SS initially cared for in a prehospital setting of a mobile intensive care unit (MICU)., Methods: From April 6, 2016 through December 31, 2021, 530 patients with SS cared for at a prehospital MICU were analyzed retrospectively. Initial SI, MSI, DSI, and ASI values, that is, first measurement after MICU arrival to the scene were calculated. A propensity score analysis with inverse probability of treatment weighting (IPTW) method was used to assess the relationship between SI, DSI, MSI, and ASI and 28-day mortality., Results: SS resulted mainly from pulmonary, digestive, and urinary infections in 44%, 25%, and 17% of patients. The 28-day overall mortality was 31%. IPTW propensity score analysis indicated a significant relationship between 28-day mortality and SI (adjusted odds ratio [aOR] 1.13; 95% CI 1.01-1.26; p = 0.04), DSI (aOR 1.16; 95% CI 1.06-1.34; p = 0.03), MSI (aOR 1.03; 95% CI 1.01-1.17; p = 0.03), and ASI (aOR 3.62; 95% CI 2.63-5.38; p < 10 -6 )., Conclusions: SI, DSI, MSI, and ASI were significantly associated with 28-day mortality among patients with SS cared for at a prehospital MICU. Further studies are needed to confirm the usefulness of SI and SI derivates for prehospital SS optimal triaging., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Hemorrhagic shock is an emergency, which may benefit from a medicalized prehospital care. Our goal was to survey the means available in the 370 French prehospital medicalized emergency services (SMUR) for hemorrhagic situations., Methods: Multicenter descriptive observational study by email then phone with all the 370 French SMUR leaders. The questionnaire was created by investigators of the project through a Delphi method, and was about service protocols concerning hemorrhagic patient care, hemorrhagic parameters measure equipment available, intravenous solutes and drugs as well as various medical devices useful or perceived to be useful to support prehospital hemorrhagic shock. The results are expressed in numbers and percentages., Results: The overall response rate was 48% (n=178). Protocols were established in between 43% (n=76) and 47% (n=83) according to etiology, measuring devices were available in 5% (n=9) of the Smur for hemostasis up to 89% (n=158) for hemoglobin measurement. Available intravenous solutes were mainly isotonic salty serum (95%, n=169), hydroxylethylstarch (83%, n=148) and Ringer lactate (73%, n=130). Tranexamic acid was available in 84 (47%) Smur. The teams had access to erythrocytes concentrates, fresh frozen plasma and platelets in 84% (n=150), 44% (n=79) and 23% (n=41) respectively. Eighty-one (46%) Smur had tourniquets and 127 (71%) anti-shock trousers. Finally, 57 (32%) had a pelvic restraint belt., Conclusion: There is a great disparity in the means available in the French Smur for the support of prehospitalization bleeding. The majority the Smur physicians can transfuse in a prehospital setting. On the other hand, a minority of teams can actively warm patients, employ tranexamic acid or use pelvic restraint belts., (Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

Background: Intracardiac shunts are rare but very serious lesions after non-penetrating chest trauma. Their diagnosis is difficult. This pathology often goes unrecognized in the context of multiple trauma., Case Report: We report the case of a 21-year-old man involved in a motor vehicle crash who presented with multiple injuries including myocardial contusion, severe brain injury, multiple pelvic fractures, closed femur fracture, bilateral lung contusion with a right pneumothorax, and intra-abdominal injuries. Three days after the initial event, a new cardiac murmur and complete heart block appeared. Transthoracic echocardiography (echo) followed by transesophageal echo revealed a high-velocity flow communication between the left ventricle and the right atrium. The patient underwent delayed cardiac surgery due to other unstable injuries. The hospital course was prolonged but favorable, and the patient left the hospital 1 month later without any neurologic or cardiologic after-effect., Conclusion: This case highlights the potential for cardiac complications to occur in any patient with serious thoracic trauma. Transesophageal echo should be performed on any trauma patient with electrocardiographic abnormalities., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Introduction: The development of emergency medicine in France and its valuation can take place only through acknowledged scientific publications. The aim of our study was to analyze the publications of French teams in emergency medicine since 2006., Material and Methods: Observational, descriptive study, from January 1st, 2006 to December 31st, 2010 including, thanks to Medline, studies related to emergency medicine with, as keywords, "medicine d'urgences; urgences; emergency; emergency medicine; French; France" the names of heads of the emergency departments, of the urgent medical aid services (samu) and of anaesthetics services in mainland France. Data collection focused on the type of study, subject, place of conducting the study and grade of international quality., Results: Three hundred and twenty-five publications were listed: 39% (n=126) of the studies were carried out in prehospital. We identified 28% of observational studies (n=92), 20% of randomized prospective (n=66), 19% of cohorts (n=62), 18% of case reports (n=59), 10% of clarifications (n=32) and 4% of general reviews (n=11). The most frequent theme was the cardiology (38% of cases). The most favourite journal was the Annales françaises d'anesthésie et de réanimation (Afar) (18%, n=57)., Conclusion: The release of French studies in emergency medicine is increasing, with an improvement in the quality of the published studies. All these results demonstrate the progress made since five years in emergency medicine in France but also the work that remains to be done in our rising medical specialization., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objectives: To find out prehospital factors linked with low pain on arrival into a traumatic emergency unit., Methods: A 4-month monocentric prospective study, including patients recruited at their arrival into a traumatic emergency unit. Pain (with a numerical rating scale [NRS]), anxiety, prehospital care including the type of transportation (physician staffed ambulances {service mobile d'urgence et de réanimation [Smur]}, emergency medical technicians, or firemen ambulances), immobilization and analgesics used were evaluated. These data were collected on arrival at the hospital by the ED orientation nurse. Uni- and multivariate analysis were performed to identify low pain's predictive factors (e.g. with a NRS ≤3)., Results: Three hundred and four patients were recruited, mean age=51±25, sex ratio=1.8, mean pain/10=5.8±2.9, 64% with a moderate or severe pain on arrival (NRS>3). For one third of patients, immobilizations hadn't been performed during the prehospital phase. Medical management by Smur is a low pain predictive factor (OR=5.8; CI 95%=1.4-24.16), anxiety is a pejorative factor (OR=0.53 CI 95%=0.38-0.75)., Conclusion: Our study highlights the physician staffed ambulances' effectiveness in prehospital trauma victims' management and raises the question of anxiolysis as an adjuvant for traumatic pain management., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Study Objective: To determine whether a new transdermal fentanyl patch (TFP) is a good choice for the postoperative pain management of patients undergoing primary total hip arthroplasty compared with patient-controlled analgesia (PCA)., Design: Randomized, prospective study., Setting: University hospital., Patients: 30 patients undergoing primary total hip arthroplasty., Interventions: Patients received either a TFP (group T; Duragesic 50 microg/h, matrix fentanyl patch, Janssen-Cilag) applied approximately 10 hours before induction of general anesthesia and PCA programmed in the postanesthesia care unit (PACU), or PCA programmed in the PACU (group P)., Measurements: Intraoperative sufentanil and additional postoperative morphine administration were recorded, as well as visual analog scores and routine vital signs at predetermined intervals during the first 48 hours., Main Results: Morphine consumption on arrival in the PACU was 3.5+/-3 mg in group T versus 13+/-5 mg in group P (P<0.0001). Visual analog scores on arrival in the PACU were 37+/-22 mm in group T versus 73+/-13 mm in group P (P<0.0001). Cumulative morphine consumption at the 24th hour was 43+/-16 mg in group P and 4+/-3 mg in group T (P<0.0001). Cumulative morphine consumption at the 48th hour was 54+/-26 mg in group P and 5+/-4 mg in group T (P<0.0001). Intraoperative sufentanil consumption was 38+/-15 microg in group T versus 30+/-5 microg in group P (not significant). The sedation score was 0 in both groups during the first 48 postoperative hours., Conclusions: Preoperative TFP application decreases pain scores and morphine consumption in the PACU and appears to have prolonged effects spanning the first 48 postoperative hours.

We report the case of a successful interscalene block for the pain management of a glenohumeral luxation in prehospital care. Interscalene block is an attractive technique in prehospital pain management. However, this regional anaesthesia technique must be performed only by a skilled anaesthesiologist.

Case report of a patient with tonsillitis treated with anti-inflammatory. The patient presented a dyspnoea and finally a cardiac arrest. The oral intubation was impossible and cricothyrotomy had to be performed with a catheter over needle technique. We found a total airway obstruction due to an epiglottis abscess. The patient died few days later of sepsis. We recommend having wire-guided cricothyrotomy technique or catheter-over-needle technique in all prehospital emergency unit and having emergency physician trained to the cricothyrotomy technique.