RESUMEN
Non-invasive positive pressure ventilation (NIPPV) has become a major therapeutic of acute respiratory failure. Thanks to technical progress, its use has become widespread in intensive care units and now in emergency and pneumology departments, for indications recognized and validated as decompensation of chronic obstructive pulmonary disease and acute cardiogenic pulmonary edema. Patients with this conditions transit in the hospital, from the emergency or pulmonology departments, sometimes through intensive care units. Knowledge of the NIPPV, its indications, contraindications, terms of use and surveillance requires trained teams. This training covers not only the technical but also the hardware, multiple ventilation modes, and interfaces. Other indications being evaluated, such as ventilation in the perioperative period, also require coordination between different actors. The establishment of a specific group of thinking and working around the NIPPV is clearly needed, allowing teams of hospital (emergency department, intensive care unit, pulmonology, anesthesia) to work together. This work deals with different areas: training, equipment, condition of receiving patients in the different services within the constraints of personnel and equipment. In this article, we trace the point of view of each of the professionals in this group and some of the actions implemented.
Asunto(s)
Vías Clínicas , Ventilación no Invasiva/estadística & datos numéricos , Insuficiencia Respiratoria/terapia , Enfermedad Aguda , Contraindicaciones , Vías Clínicas/organización & administración , Vías Clínicas/normas , Servicios Médicos de Urgencia/organización & administración , Francia , Hospitales , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/normas , Ventilación no Invasiva/normas , Neumología/organización & administración , Neumología/normasAsunto(s)
Resistencia a la Ampicilina , Antibacterianos , Infecciones por Haemophilus/tratamiento farmacológico , Infecciones por Haemophilus/epidemiología , Haemophilus influenzae/efectos de los fármacos , Resistencia betalactámica , Antibacterianos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/prevención & control , Infecciones por Haemophilus/microbiología , HumanosAsunto(s)
Enterococcus faecalis , Infecciones por Bacterias Grampositivas/patología , Neumonía Bacteriana/patología , Anciano , Antibacterianos/uso terapéutico , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Huésped Inmunocomprometido , Cirrosis Hepática Alcohólica/complicaciones , Trasplante de Hígado , Imagen por Resonancia Magnética , Masculino , Necrosis , Neumonía Bacteriana/microbiologíaRESUMEN
We report the case of a patient who presented, during a hip replacement, a cardiogenic shock following a myocardial infarction. After a successful resuscitation of three cardiac arrests, an intra-aortic balloon pump was inserted, then the patient could have been transferred to the nearest cardiac catheterization laboratory for a percutaneous dilatation of the right coronary artery, allowing the patient to have favourable outcome. Treatment of perioperative myocardial infarction is not really standardized. This case report depicts that in such critical condition, insertion of an intra-aortic balloon pump with early percutaneous angioplasty for acute peroperative myocardial infarction is a valuable option.
Asunto(s)
Complicaciones Intraoperatorias/terapia , Infarto del Miocardio/terapia , Enfermedad Aguda , Anciano , Angioplastia Coronaria con Balón , Artroplastia de Reemplazo de Cadera , Cateterismo Cardíaco , Angiografía Coronaria , Electrocardiografía , Paro Cardíaco/terapia , Humanos , Contrapulsador Intraaórtico , Masculino , Monitoreo Intraoperatorio , ResucitaciónRESUMEN
We report a case of myocarditis mimicking acute lateral myocardial infarction and treated as such initially, which was complicated by ventricular fibrillation a few hours after admission to the intensive care unit. The correct diagnosis was rapidly made using a low-dose delayed-enhanced cardiac multidetector computed tomography scan performed immediately after a normal coronary angiogram, demonstrating typical myocardial late hyperenhancement and good correlation with delayed enhanced magnetic resonance imaging. This case suggests that myocarditis can be accurately diagnosed by delayed-enhanced cardiac multidetector computed tomography in an emergency setting. The other lesson from this case is that patients presenting with severe clinical symptoms, important ECG signs and high myocardial enzyme levels should be closely monitored for at least 72 hours, even when myocardial infarction has been excluded.