This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
Goal: To provide healthcare professionals with comprehensive multidisciplinary expert recommenda-... more Goal: To provide healthcare professionals with comprehensive multidisciplinary expert recommenda- tions for the acute care of severe limb trauma patients, both during the prehospital phase and after admission to a Trauma Centre. Design: A consensus committee of 21 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE1) system to guide assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations remained non-graded. Methods: The committee addressed eleven questions relevant to the patient suffering severe limb trauma: 1) What are the key findings derived from medical history and clinical examination which lead to the patient’s prompt referral to a Level 1 or Level 2 Trauma Centre? 2) What are the medical devices that must be implemented in the prehospital setting to reduce blood loss? 3) Which are the clinical findings prompting the performance of injected X-ray examinations? 4) What are the ideal timing and modalities for performing fracture fixation? 5) What are the clinical and operative findings which steer the surgical approach in case of vascular compromise and/or major musculoskeletal attrition? 6) How to best prevent infection? 7) How to best prevent thromboembolic complications? 8) What is the best strategy to precociously detect and treat limb compartment syndrome? 9) How to best and precociously detect post-traumatic rhabdomyolysis and prevent rhabdomyolysis-induced acute kidney injury? 10) What is the best strategy to reduce the incidence of fat emboli syndrome and post-traumatic systemic inflammatory response? 11) What is the best therapeutic strategy to treat acute trauma-induced pain? Every question was formulated in a PICO (Patient Intervention Comparison Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE1 methodology. Results: The experts’ synthesis work and the application of the GRADE method resulted in 19 recommendations. Among the formalised recommendations, 4 had a high level of evidence (GRADE 1+/) and 12 had a low level of evidence (GRADE 2+/). For 3 recommendations, the GRADE method could not be applied, resulting in an expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. Conclusions: There was significant agreement among experts on strong recommendations to improve practices for severe limb trauma patients.
Observation, interprétation, actions d’amélioration, remises en question sont autant de termes qu... more Observation, interprétation, actions d’amélioration, remises en question sont autant de termes qui font écho à la situation des soignants depuis l’arrivée en France de l’épidémie de Covid-19, début 2020. Tous les intervenants de la chaîne de soins ont dû faire face à l’afflux de patients et se montrer capables de voir leurs pratiques évoluer au jour le jour. Ce qui était recommandé quelques semaines auparavant pouvait rapidement devenir obsolète. Il fallait être réactif et la question des traitements médicamenteux était au coeur des préoccupations, imposant aux prescripteurs de se tenir informés et aux pharmaciens d’être le plus mobilisés possible pour répondre aux demandes du terrain dans les meilleurs délais. Observation, interpretation, actions for improvement, questioning are all terms that echo the situation of caregivers since the outbreak of the COVID-19 epidemic in France at the beginning of 2020. All those involved in the healthcare chain have had to cope with the infl ux of patients and to show that they are capable of seeing their practices evolve on a daily basis. What was recommended a few weeks earlier could quickly become obsolete. It was necessary to be reactive and the question of drug treatments was at the heart of the concerns, requiring prescribers to keep themselves informed and pharmacists to be as mobilized as possible to respond to requests from the fi eld as quickly as possible.
La survenue d’un traumatisme grave des membres est un événement brutal pour tous les patients, qu... more La survenue d’un traumatisme grave des membres est un événement brutal pour tous les patients, quel qu’en soit le contexte. Très vite surgissent de nombreuses interrogations, au champ très large – du déroulé de l’intervention à la réinsertion familiale et sociale. L’infirmière diplômée d’État tient alors un rôle essentiel d’écoute, d’éducation et de soutien auprès du patient en pré- puis en postopératoire. Au-delà de la réassurance, l’infirmière est au coeur de l’organisation du retour à domicile et de l’aide au retour des activités socioprofessionnelles. eoccurrence of severe The limb trauma is a brutal event for every patient in any context. Many questions quickly arise, and the role of the nurse is essential in listening, educating and supporting the patient in the pre and postoperatively. The scope of the questions is wide, from information on the course of the operation to the patient’s family and social reintegration postoperatively. In addition to reinsurance, the state registered nurse will play a central role in organising the return home and helping the patient to return to socio-professional activities.
Le rôle de l’infirmière au service d’accueil des urgences s’est complexifié ces dernières années ... more Le rôle de l’infirmière au service d’accueil des urgences s’est complexifié ces dernières années au regard de l’évolution de ces services. La particularité de ce poste tient dans l’autonomie, l’adaptation, l’ajustement et la capacité d’anticipation ainsi que dans la participation au diagnostic. Illustration, par un cas concret, du rôle central de l’infirmière dans la chaîne de soins pluridisciplinaire d’un traumatisé des membres, de son accueil au traitement. The position of the nurse in the emergency reception service is central. Her role has become more complicated in recent years with the evolution of the emergency services. The particularity of the nurse on duty in the emergency department lies in autonomy, adaptation, adjustment and the ability to anticipate, as well as in participating in the diagnosis. A concrete case will illustrate her role in the multidisciplinary care chain of a victim of limb trauma, from reception to treatment.
Le traumatisme de membre est une pathologie fréquente en préhospitalier. Le soignant primo-interv... more Le traumatisme de membre est une pathologie fréquente en préhospitalier. Le soignant primo-intervenant joue un rôle primordial en termes d’application des soins initiaux afin de sauver le membre et la vie du patient et de limiter les conséquences fonctionnelles. Il doit suivre pour cela des règles strictes de sécurité et d’efficacité. La qualité de son évaluation initiale le guidera vers les soins les plus adaptés et vers la chronologie adéquate. Limb trauma is a frequent pathology in pre-hospital care. The first responder caregiver plays a crucial role in terms of the application of the initial care in order to save the limb and life of the patient and to limit the functional consequences. He has to follow strict rules of safety and efficiency. The quality of his initial assessment will guide him towards the most appropriate care and the appropriate chronology.
La prise en charge d’un patient victime d’un traumatisme sévère de membre débute par une évaluati... more La prise en charge d’un patient victime d’un traumatisme sévère de membre débute par une évaluation rapide des lésions et de leurs priorités thérapeutiques pour orienter le blessé vers un centre spécialisé de traumatologie. Le pronostic est double à la fois vital et fonctionnel reposant sur la qualité des soins immédiats en pré-hospitalier, des soins spécifiques hospitaliers et sur la prévention des complications secondaires. The management of a patient with limb trauma begins with a rapid assessment of the lesions in order to prioritise the treatment of life-threatening lesions, primarily haemorrhage. Severe limb trauma is defined by the presence of specific severity criteria and requires the injured person to be referred to a specialised severe trauma centre. The prognosis is twofold, both vital and functional, based on the speed as well as the quality of immediate pre-hospital care, specific hospital care and the prevention of secondary complications.
Les consommations alimentaires évoluent. Dans un cadre de santé publique, des recommandations son... more Les consommations alimentaires évoluent. Dans un cadre de santé publique, des recommandations sont régulièrement mises à jour en fonction de l'état nutritionnel et de santé de la population française mais certaines d'entre elles restent peu suivies. Dans le contexte épidémique actuel, une prise en charge nutritionnelle doit être initiée aussi bien chez les populations à risque que chez les patients présentant ou ayant présenté le COVID 19 afin de favoriser immunité et récupération. Eating habits are evolving. In a public health context, guidelines are regularly updated according to the nutritional status and health of the French population, but some of these recommendations go unheeded. In the context of the current epidemic, nutritional care must be provided to high risk populations as well as to patients presenting, or having presented, COVID-19, in order to favour immunity and recovery.
L’infection à la Covid-19 entraîne une réaction inflammatoire non contenue pour les formes graves... more L’infection à la Covid-19 entraîne une réaction inflammatoire non contenue pour les formes graves. Le système nerveux autonome (SNA), en particulier la branche parasympathique, participe à la régulation de la réponse inflammatoire. Un dysfonctionnement de cette branche fréquente chez les personnes à risque de développer la Covid-19 favorise un effet pro-inflammatoire. Renforcer et stimuler le SNA parasympathique est possible et accessible aux acteurs paramédicaux comme médicaux. COVID-19 infection results in an unrestrained inflammatory reaction in serious cases. The autonomic nervous system (ANS), in particular the parasympathetic branch, helps to regulate the inflammatory response. A dysfunction of this branch, frequent in people at risk of developing COVID-19, favours a pro-inflammatory effect. Reinforcing and stimulating the parasympathetic ANS is possible and accessible to paramedical and medical professionals.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are
Goal: To provide healthcare professionals with comprehensive multidisciplinary expert recommenda-... more Goal: To provide healthcare professionals with comprehensive multidisciplinary expert recommenda- tions for the acute care of severe limb trauma patients, both during the prehospital phase and after admission to a Trauma Centre. Design: A consensus committee of 21 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE1) system to guide assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations remained non-graded. Methods: The committee addressed eleven questions relevant to the patient suffering severe limb trauma: 1) What are the key findings derived from medical history and clinical examination which lead to the patient’s prompt referral to a Level 1 or Level 2 Trauma Centre? 2) What are the medical devices that must be implemented in the prehospital setting to reduce blood loss? 3) Which are the clinical findings prompting the performance of injected X-ray examinations? 4) What are the ideal timing and modalities for performing fracture fixation? 5) What are the clinical and operative findings which steer the surgical approach in case of vascular compromise and/or major musculoskeletal attrition? 6) How to best prevent infection? 7) How to best prevent thromboembolic complications? 8) What is the best strategy to precociously detect and treat limb compartment syndrome? 9) How to best and precociously detect post-traumatic rhabdomyolysis and prevent rhabdomyolysis-induced acute kidney injury? 10) What is the best strategy to reduce the incidence of fat emboli syndrome and post-traumatic systemic inflammatory response? 11) What is the best therapeutic strategy to treat acute trauma-induced pain? Every question was formulated in a PICO (Patient Intervention Comparison Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE1 methodology. Results: The experts’ synthesis work and the application of the GRADE method resulted in 19 recommendations. Among the formalised recommendations, 4 had a high level of evidence (GRADE 1+/) and 12 had a low level of evidence (GRADE 2+/). For 3 recommendations, the GRADE method could not be applied, resulting in an expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. Conclusions: There was significant agreement among experts on strong recommendations to improve practices for severe limb trauma patients.
Observation, interprétation, actions d’amélioration, remises en question sont autant de termes qu... more Observation, interprétation, actions d’amélioration, remises en question sont autant de termes qui font écho à la situation des soignants depuis l’arrivée en France de l’épidémie de Covid-19, début 2020. Tous les intervenants de la chaîne de soins ont dû faire face à l’afflux de patients et se montrer capables de voir leurs pratiques évoluer au jour le jour. Ce qui était recommandé quelques semaines auparavant pouvait rapidement devenir obsolète. Il fallait être réactif et la question des traitements médicamenteux était au coeur des préoccupations, imposant aux prescripteurs de se tenir informés et aux pharmaciens d’être le plus mobilisés possible pour répondre aux demandes du terrain dans les meilleurs délais. Observation, interpretation, actions for improvement, questioning are all terms that echo the situation of caregivers since the outbreak of the COVID-19 epidemic in France at the beginning of 2020. All those involved in the healthcare chain have had to cope with the infl ux of patients and to show that they are capable of seeing their practices evolve on a daily basis. What was recommended a few weeks earlier could quickly become obsolete. It was necessary to be reactive and the question of drug treatments was at the heart of the concerns, requiring prescribers to keep themselves informed and pharmacists to be as mobilized as possible to respond to requests from the fi eld as quickly as possible.
La survenue d’un traumatisme grave des membres est un événement brutal pour tous les patients, qu... more La survenue d’un traumatisme grave des membres est un événement brutal pour tous les patients, quel qu’en soit le contexte. Très vite surgissent de nombreuses interrogations, au champ très large – du déroulé de l’intervention à la réinsertion familiale et sociale. L’infirmière diplômée d’État tient alors un rôle essentiel d’écoute, d’éducation et de soutien auprès du patient en pré- puis en postopératoire. Au-delà de la réassurance, l’infirmière est au coeur de l’organisation du retour à domicile et de l’aide au retour des activités socioprofessionnelles. eoccurrence of severe The limb trauma is a brutal event for every patient in any context. Many questions quickly arise, and the role of the nurse is essential in listening, educating and supporting the patient in the pre and postoperatively. The scope of the questions is wide, from information on the course of the operation to the patient’s family and social reintegration postoperatively. In addition to reinsurance, the state registered nurse will play a central role in organising the return home and helping the patient to return to socio-professional activities.
Le rôle de l’infirmière au service d’accueil des urgences s’est complexifié ces dernières années ... more Le rôle de l’infirmière au service d’accueil des urgences s’est complexifié ces dernières années au regard de l’évolution de ces services. La particularité de ce poste tient dans l’autonomie, l’adaptation, l’ajustement et la capacité d’anticipation ainsi que dans la participation au diagnostic. Illustration, par un cas concret, du rôle central de l’infirmière dans la chaîne de soins pluridisciplinaire d’un traumatisé des membres, de son accueil au traitement. The position of the nurse in the emergency reception service is central. Her role has become more complicated in recent years with the evolution of the emergency services. The particularity of the nurse on duty in the emergency department lies in autonomy, adaptation, adjustment and the ability to anticipate, as well as in participating in the diagnosis. A concrete case will illustrate her role in the multidisciplinary care chain of a victim of limb trauma, from reception to treatment.
Le traumatisme de membre est une pathologie fréquente en préhospitalier. Le soignant primo-interv... more Le traumatisme de membre est une pathologie fréquente en préhospitalier. Le soignant primo-intervenant joue un rôle primordial en termes d’application des soins initiaux afin de sauver le membre et la vie du patient et de limiter les conséquences fonctionnelles. Il doit suivre pour cela des règles strictes de sécurité et d’efficacité. La qualité de son évaluation initiale le guidera vers les soins les plus adaptés et vers la chronologie adéquate. Limb trauma is a frequent pathology in pre-hospital care. The first responder caregiver plays a crucial role in terms of the application of the initial care in order to save the limb and life of the patient and to limit the functional consequences. He has to follow strict rules of safety and efficiency. The quality of his initial assessment will guide him towards the most appropriate care and the appropriate chronology.
La prise en charge d’un patient victime d’un traumatisme sévère de membre débute par une évaluati... more La prise en charge d’un patient victime d’un traumatisme sévère de membre débute par une évaluation rapide des lésions et de leurs priorités thérapeutiques pour orienter le blessé vers un centre spécialisé de traumatologie. Le pronostic est double à la fois vital et fonctionnel reposant sur la qualité des soins immédiats en pré-hospitalier, des soins spécifiques hospitaliers et sur la prévention des complications secondaires. The management of a patient with limb trauma begins with a rapid assessment of the lesions in order to prioritise the treatment of life-threatening lesions, primarily haemorrhage. Severe limb trauma is defined by the presence of specific severity criteria and requires the injured person to be referred to a specialised severe trauma centre. The prognosis is twofold, both vital and functional, based on the speed as well as the quality of immediate pre-hospital care, specific hospital care and the prevention of secondary complications.
Les consommations alimentaires évoluent. Dans un cadre de santé publique, des recommandations son... more Les consommations alimentaires évoluent. Dans un cadre de santé publique, des recommandations sont régulièrement mises à jour en fonction de l'état nutritionnel et de santé de la population française mais certaines d'entre elles restent peu suivies. Dans le contexte épidémique actuel, une prise en charge nutritionnelle doit être initiée aussi bien chez les populations à risque que chez les patients présentant ou ayant présenté le COVID 19 afin de favoriser immunité et récupération. Eating habits are evolving. In a public health context, guidelines are regularly updated according to the nutritional status and health of the French population, but some of these recommendations go unheeded. In the context of the current epidemic, nutritional care must be provided to high risk populations as well as to patients presenting, or having presented, COVID-19, in order to favour immunity and recovery.
L’infection à la Covid-19 entraîne une réaction inflammatoire non contenue pour les formes graves... more L’infection à la Covid-19 entraîne une réaction inflammatoire non contenue pour les formes graves. Le système nerveux autonome (SNA), en particulier la branche parasympathique, participe à la régulation de la réponse inflammatoire. Un dysfonctionnement de cette branche fréquente chez les personnes à risque de développer la Covid-19 favorise un effet pro-inflammatoire. Renforcer et stimuler le SNA parasympathique est possible et accessible aux acteurs paramédicaux comme médicaux. COVID-19 infection results in an unrestrained inflammatory reaction in serious cases. The autonomic nervous system (ANS), in particular the parasympathetic branch, helps to regulate the inflammatory response. A dysfunction of this branch, frequent in people at risk of developing COVID-19, favours a pro-inflammatory effect. Reinforcing and stimulating the parasympathetic ANS is possible and accessible to paramedical and medical professionals.
Le patient expert est souvent évoqué pour qualifier les patients atteints de maladies chroniques ... more Le patient expert est souvent évoqué pour qualifier les patients atteints de maladies chroniques qui, très souvent, suivent une formation en éducation thérapeutique. Les auteurs souhaitent démontrer que ce concept peut être étendu à tous les patients, pour en faire des patients partenaires de leur guérison, au cœur de leur processus de soin. Expert inné de sa santé, le patient invite autour de son parcours de prise en charge de multiples acteurs, soignants mais également accompagnateurs et aidants. S’appuyant sur une enquête et des situations cliniques variées, les auteurs proposent d’élargir le champ de vision des soignants, mais également des patients et proches aidants, sur les dynamiques fondamentales liant tous ces acteurs des soins pouvant les amener vers l’expertise. Avec un accompagnement bienveillant, compréhensible et cohérent, le patient n’est plus passif. Il acquiert un statut de partenaire de plus en plus actif. Confiant en ce riche réseau de soins autour de lui, il acquiert une densité de savoirs propice à la prise de décision, en pleine autonomie et en toute sécurité. L’intelligence collective autour des parcours de soins, de santé et de vie du patient autorise un raisonnement clinique supérieur, pour des ajustements efficients. Le patient peut être ainsi reconnu expert. Ces enjeux sont majeurs pour nos relations interpersonnelles et nos systèmes de soins. Ils imposent un langage commun et intelligible par tous qui doivent être pris en compte dans les parcours de formation initiaux ou continus des acteurs du soin.
après une année 2015 tristement dense en rencontres chaotiques mais ayant fortement sollicité le ... more après une année 2015 tristement dense en rencontres chaotiques mais ayant fortement sollicité le pouvoir de se transcender des Français et de la France, voici un ouvrage particulièrement dense et synthétique pour mieux comprendre ce qui fait le stress, le trauma... comment se densifier en amont et en aval pour mieux gérer ces rencontres potentiellement traumatisantes. Celles qui font qu'il y a un avant et un après...
Ce livre ne s'adresse pas seulement aux soignants de la santé... mais aussi aux soignants que nous sommes tous. S'il est bien une chose que l'on apprend sur le terrain dans la fulgurance de ces instants ou dans la gestion d'autres moments de cinétique plus longue, c'est que la notion de soin et d'abord une question de présence. Professionnels des ressources humaines, du management, en gestion de crise, administrateurs, mais aussi monsieur tout le monde trouveront ici du matériel pour mieux comprendre, savoir pour agir et ne plus subir.
Un formidable outil de densification personnelle.
Les traumatismes, stress, drames et autres accidents de la vie relèvent autant d’événements de la vie quotidienne que de situations exceptionnelles comme les catastrophes naturelles, les guerres ou les attentats. En certaines circonstances, l’appareil psychique est débordé par ces événements, une souffrance s’installe, et une aide adaptée est alors nécessaire pour prendre en charge ces « blessures invisibles »
Fondé sur la grande expérience de l’auteur et sur des histoires cliniques, l’ouvrage définit les différents tableaux cliniques (état de stress post-traumatique, harcèlement moral, burn-out, traumatisme sexuel, syndrome de Lazare, résilience…) et les diverses techniques disponibles de prise en charge (défusing, débriefing, psychothérapies, EMDR…) et de prévention
Des exemples concrets présentent enfin les modalités d’action selon les circonstances (prise d’otage, deuil collectif, guerre, catastrophe, camp de réfugiés) et selon le lieu de la prise en charge (institution, travail avec un interprète…)
Inscrit au cœur d’une pratique quotidienne, tout en s’appuyant sur des connaissances théoriques, l’ouvrage s’adresse aux thérapeutes, médecins, psychiatres, psychologues, infirmiers et ą tous les soignants qui accompagnent les personnes touchées par un traumatisme psychique.
Objectif : Élaborer un référentiel français multidisciplinaire qui aborde la prise en charge init... more Objectif : Élaborer un référentiel français multidisciplinaire qui aborde la prise en charge initiale, pré- et intra-hospitalière, d’un patient victime de traumatisme sévère de membre(s). Conception : Un comité de consensus de 21 experts a été constitué. Une politique de déclaration et de suivi des liens d’intérêts a été appliquée et respectée durant tout le processus de réalisation du référentiel. De même, celui-ci n’a bénéficié d’aucun financement provenant d’une entreprise commercialisant un produit de santé (médicament ou dispositif médical). Le comité de consensus devait respecter et suivre la méthode GRADE® (Grading of Recommendations Assessment, Development and Evaluation) pour évaluer la qualité des données factuelles sur lesquelles étaient fondées les recommandations. Les inconvénients potentiels de faire des recommandations fortes en présence de données factuelles de mauvaise qualité ou insuffisantes ont été soulignés. Peu de recommandations ont été non gradées. Méthodes : Le comité a étudié onze questions relatives au traumatisme sévère de membre(s) : 1) Quels sont les éléments anamnestiques et clinique de gravité qui doivent indiquer l’admission du patient en structure d'accueil des traumatisés graves ? 2) Quels moyens doivent être implémentés en pré-hospitalier pour réduire le saignement ? 3) Quels sont les éléments cliniques qui doivent conduire à la réalisation d’examens radiographiques avec injection ? 4) Quels sont le moment et les modalités de réalisation de l’ostéosynthèse ? 5) Quels sont les éléments qui permettent d’orienter la stratégie chirurgicale en cas d’atteinte vasculaire et/ou de délabrement majeur ? 6) Quelles sont les modalités de prévention du risque septique 7) Quelles sont les modalités de prévention de la maladie thromboembolique veineuse ? 8) Quels sont les moyens de détection et de traitement précoces du syndrome de loges post-traumatique ? 9) Quels sont les moyens de détecter la rhabdomyolyse aigüe post-traumatique et de prévenir ses complications rénales ? 10) Comment réduire l’incidence de l’embolie graisseuse et des autres atteintes inflammatoires systémiques post-traumatiques ? 11) Quelles sont les modalités thérapeutiques de contrôle de la douleur aigüe ? Chaque question a été formulée selon un format PICO (Patient Intervention Comparison Outcome) puis les profils de preuve ont été produits. L'analyse de la littérature et les recommandations ont été formulées selon la méthodologie GRADE®. Résultats : Le travail de synthèse des experts et l’application de la méthode GRADE® ont abouti à l’élaboration de 19 recommandations. Parmi les recommandations formalisées, quatre avaient un niveau de preuve élevé (GRADE 1±) et douze un niveau de preuve faible (GRADE 2±). Pour trois recommandations, la méthode GRADE ne pouvait pas s’appliquer, aboutissant à un avis d’experts. Après deux tours de cotation et un amendement, un accord fort a été obtenu pour l’ensemble des recommandations. Conclusion : Un accord fort existait parmi les experts sur des recommandations importantes, transdisciplinaires, dont la finalité est l’amélioration des pratiques de prise en charge des patients victimes de traumatisme sévère de membre(s).
Soignant de la Covid19 nous le sommes tous, en première ligne pour les professionnels de santé, q... more Soignant de la Covid19 nous le sommes tous, en première ligne pour les professionnels de santé, que ce soit en seconde ligne pour le patient partenaire et le #citoyen4M, pilier de résilience de notre système de santé. Voici la CovidBox, totalement gratuite, pour diffuser au mieux les bonnes pratiques, comprendre pour agir, se former initialement pour ceux qui souhaiteraient renforcer les rangs de première ligne, se former en continue et posséder dans la poche les outils du prendre soin au quotidien, via la plateforme 360 medics, avec Alexis Bataille-Hembert, aide-soignant, Gilles Chollet, infirmier libéral, et Hugues Lefort, médecin. Il fallait regrouper les repères de compréhension clinique, éthique, du soin, les référentiels, les outils du quotidien au lit du patient (domicile, service et réanimation), et plus encore... Nous avons plein de surprises à venir. Une première version qui a vocation à la densification par vos propositions d'amélioration, de rectification. Si vous voulez supporter l'application, contactez 360medics, nous irons encore plus vite et plus loin, car ensemble.
La brûlure est l'accident de la vie courante le plus fréquent chez l'enfant en France, et 50 % de... more La brûlure est l'accident de la vie courante le plus fréquent chez l'enfant en France, et 50 % des brûlures touchent l'enfant de moins de 2 ans. La prévention des risques liés à la vie courante reste donc un enjeu de santé publique surtout lorsque l'enfant commence à se déplacer seul. ■ Attention au sur-accident lors de la prise en charge de l'enfant brûlé grave aux premiers instants. ■ Trois actions doivent être comprises par le soignant primo-intervenant : refroidir la brûlure mais pas le brûlé, lutte contre l'hypovolémie, et prise en charge de la douleur. ■ L'évaluation de la gravité de la brûlure est impérative car conditionne le pronostic vital de l'enfant. Elle dépend de la brûlure : étendue, profondeur, localisation, type ; des lésions associées ; et de l'enfant : âge, comorbidités. ■ La main avec les doigts de l'enfant correspond à 1 % de surface corporelle totale (SCT) et permet d'évaluer la surface corporelle brûlée (SCB).
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Papers by Hugues Lefort
tions for the acute care of severe limb trauma patients, both during the prehospital phase and after admission to a Trauma Centre.
Design: A consensus committee of 21 experts was formed. A formal conflict-of-interest (COI) policy was
developed at the onset of the process and enforced throughout. The entire guidelines process was
conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors
were advised to follow the rules of the Grading of Recommendations Assessment, Development and
Evaluation (GRADE1) system to guide assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations remained non-graded.
Methods: The committee addressed eleven questions relevant to the patient suffering severe limb trauma: 1) What are the key findings derived from medical history and clinical examination which lead to the patient’s prompt referral to a Level 1 or Level 2 Trauma Centre? 2) What are the medical devices that must be implemented in the prehospital setting to reduce blood loss? 3) Which are the clinical findings prompting the performance of injected X-ray examinations? 4) What are the ideal timing and modalities for performing fracture fixation? 5) What are the clinical and operative findings which steer
the surgical approach in case of vascular compromise and/or major musculoskeletal attrition? 6) How to
best prevent infection? 7) How to best prevent thromboembolic complications? 8) What is the best
strategy to precociously detect and treat limb compartment syndrome? 9) How to best and precociously
detect post-traumatic rhabdomyolysis and prevent rhabdomyolysis-induced acute kidney injury? 10)
What is the best strategy to reduce the incidence of fat emboli syndrome and post-traumatic systemic
inflammatory response? 11) What is the best therapeutic strategy to treat acute trauma-induced pain?
Every question was formulated in a PICO (Patient Intervention Comparison Outcome) format and the
evidence profiles were produced. The literature review and recommendations were made according to the GRADE1 methodology.
Results: The experts’ synthesis work and the application of the GRADE method resulted in 19 recommendations. Among the formalised recommendations, 4 had a high level of evidence (GRADE 1+/) and 12 had a low level of evidence (GRADE 2+/). For 3 recommendations, the GRADE method could not be applied, resulting in an expert advice. After two rounds of scoring and one amendment,
strong agreement was reached on all the recommendations.
Conclusions: There was significant agreement among experts on strong recommendations to improve
practices for severe limb trauma patients.
dans les meilleurs délais.
Observation, interpretation, actions for improvement, questioning are all terms that echo the situation of caregivers since the outbreak of the COVID-19 epidemic in France at the beginning of 2020. All those involved in the healthcare chain have had to cope with the infl ux of patients and to show that they are capable of seeing their practices evolve on a daily basis. What was recommended a few weeks earlier could quickly become obsolete. It was necessary to be reactive and the question of drug treatments was at the heart of the concerns, requiring prescribers to keep themselves informed and pharmacists to be as mobilized as possible to respond to requests from the fi eld as quickly as possible.
eoccurrence of severe
The limb trauma is a brutal event for every patient in any context. Many questions quickly arise, and the role of the nurse is essential in listening, educating and supporting the patient in the pre and postoperatively. The scope of the questions is wide, from information on the course
of the operation to the patient’s family and social reintegration postoperatively. In addition to reinsurance, the state registered nurse will play a central role in organising the return home and helping the patient to return to socio-professional activities.
de l’infirmière dans la chaîne de soins pluridisciplinaire d’un traumatisé des membres, de son accueil au traitement.
The position of the nurse in the emergency reception service is central. Her role has become more complicated in recent years with the evolution of the emergency services. The particularity of the nurse on duty in the
emergency department lies in autonomy, adaptation, adjustment and the ability to anticipate, as well as in participating in the diagnosis. A concrete case will illustrate her role in the multidisciplinary care chain of a victim of limb trauma, from reception to treatment.
Limb trauma is a frequent pathology in pre-hospital care. The first responder caregiver plays a crucial role in terms of the application of the initial care in order to save the limb and life of the patient and to limit the functional consequences. He has to follow strict rules of safety and efficiency. The quality of his initial assessment will guide him towards the most appropriate care and the appropriate chronology.
The management of a patient with limb trauma begins with a rapid assessment of the lesions in order to prioritise the treatment of life-threatening lesions, primarily haemorrhage. Severe limb trauma is
defined by the presence of specific severity criteria and requires the injured person to be referred to a specialised severe trauma centre. The prognosis is twofold, both vital and functional, based on the speed as well as the quality of immediate pre-hospital care, specific hospital care and the prevention of secondary complications.
Eating habits are evolving. In a public health context, guidelines are regularly updated according to the nutritional status and health of the French population, but some of these recommendations go unheeded. In the context of the current epidemic, nutritional care must be provided to high risk populations as well as to patients
presenting, or having presented, COVID-19, in order to favour immunity and recovery.
COVID-19 infection results in an unrestrained inflammatory reaction in serious cases. The autonomic nervous system (ANS), in particular the parasympathetic branch, helps to regulate the inflammatory response. A dysfunction of this branch, frequent in people at risk of developing COVID-19, favours a pro-inflammatory effect. Reinforcing and stimulating the parasympathetic ANS
is possible and accessible to paramedical and medical professionals.
tions for the acute care of severe limb trauma patients, both during the prehospital phase and after admission to a Trauma Centre.
Design: A consensus committee of 21 experts was formed. A formal conflict-of-interest (COI) policy was
developed at the onset of the process and enforced throughout. The entire guidelines process was
conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors
were advised to follow the rules of the Grading of Recommendations Assessment, Development and
Evaluation (GRADE1) system to guide assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations remained non-graded.
Methods: The committee addressed eleven questions relevant to the patient suffering severe limb trauma: 1) What are the key findings derived from medical history and clinical examination which lead to the patient’s prompt referral to a Level 1 or Level 2 Trauma Centre? 2) What are the medical devices that must be implemented in the prehospital setting to reduce blood loss? 3) Which are the clinical findings prompting the performance of injected X-ray examinations? 4) What are the ideal timing and modalities for performing fracture fixation? 5) What are the clinical and operative findings which steer
the surgical approach in case of vascular compromise and/or major musculoskeletal attrition? 6) How to
best prevent infection? 7) How to best prevent thromboembolic complications? 8) What is the best
strategy to precociously detect and treat limb compartment syndrome? 9) How to best and precociously
detect post-traumatic rhabdomyolysis and prevent rhabdomyolysis-induced acute kidney injury? 10)
What is the best strategy to reduce the incidence of fat emboli syndrome and post-traumatic systemic
inflammatory response? 11) What is the best therapeutic strategy to treat acute trauma-induced pain?
Every question was formulated in a PICO (Patient Intervention Comparison Outcome) format and the
evidence profiles were produced. The literature review and recommendations were made according to the GRADE1 methodology.
Results: The experts’ synthesis work and the application of the GRADE method resulted in 19 recommendations. Among the formalised recommendations, 4 had a high level of evidence (GRADE 1+/) and 12 had a low level of evidence (GRADE 2+/). For 3 recommendations, the GRADE method could not be applied, resulting in an expert advice. After two rounds of scoring and one amendment,
strong agreement was reached on all the recommendations.
Conclusions: There was significant agreement among experts on strong recommendations to improve
practices for severe limb trauma patients.
dans les meilleurs délais.
Observation, interpretation, actions for improvement, questioning are all terms that echo the situation of caregivers since the outbreak of the COVID-19 epidemic in France at the beginning of 2020. All those involved in the healthcare chain have had to cope with the infl ux of patients and to show that they are capable of seeing their practices evolve on a daily basis. What was recommended a few weeks earlier could quickly become obsolete. It was necessary to be reactive and the question of drug treatments was at the heart of the concerns, requiring prescribers to keep themselves informed and pharmacists to be as mobilized as possible to respond to requests from the fi eld as quickly as possible.
eoccurrence of severe
The limb trauma is a brutal event for every patient in any context. Many questions quickly arise, and the role of the nurse is essential in listening, educating and supporting the patient in the pre and postoperatively. The scope of the questions is wide, from information on the course
of the operation to the patient’s family and social reintegration postoperatively. In addition to reinsurance, the state registered nurse will play a central role in organising the return home and helping the patient to return to socio-professional activities.
de l’infirmière dans la chaîne de soins pluridisciplinaire d’un traumatisé des membres, de son accueil au traitement.
The position of the nurse in the emergency reception service is central. Her role has become more complicated in recent years with the evolution of the emergency services. The particularity of the nurse on duty in the
emergency department lies in autonomy, adaptation, adjustment and the ability to anticipate, as well as in participating in the diagnosis. A concrete case will illustrate her role in the multidisciplinary care chain of a victim of limb trauma, from reception to treatment.
Limb trauma is a frequent pathology in pre-hospital care. The first responder caregiver plays a crucial role in terms of the application of the initial care in order to save the limb and life of the patient and to limit the functional consequences. He has to follow strict rules of safety and efficiency. The quality of his initial assessment will guide him towards the most appropriate care and the appropriate chronology.
The management of a patient with limb trauma begins with a rapid assessment of the lesions in order to prioritise the treatment of life-threatening lesions, primarily haemorrhage. Severe limb trauma is
defined by the presence of specific severity criteria and requires the injured person to be referred to a specialised severe trauma centre. The prognosis is twofold, both vital and functional, based on the speed as well as the quality of immediate pre-hospital care, specific hospital care and the prevention of secondary complications.
Eating habits are evolving. In a public health context, guidelines are regularly updated according to the nutritional status and health of the French population, but some of these recommendations go unheeded. In the context of the current epidemic, nutritional care must be provided to high risk populations as well as to patients
presenting, or having presented, COVID-19, in order to favour immunity and recovery.
COVID-19 infection results in an unrestrained inflammatory reaction in serious cases. The autonomic nervous system (ANS), in particular the parasympathetic branch, helps to regulate the inflammatory response. A dysfunction of this branch, frequent in people at risk of developing COVID-19, favours a pro-inflammatory effect. Reinforcing and stimulating the parasympathetic ANS
is possible and accessible to paramedical and medical professionals.
Ce livre ne s'adresse pas seulement aux soignants de la santé... mais aussi aux soignants que nous sommes tous. S'il est bien une chose que l'on apprend sur le terrain dans la fulgurance de ces instants ou dans la gestion d'autres moments de cinétique plus longue, c'est que la notion de soin et d'abord une question de présence. Professionnels des ressources humaines, du management, en gestion de crise, administrateurs, mais aussi monsieur tout le monde trouveront ici du matériel pour mieux comprendre, savoir pour agir et ne plus subir.
Un formidable outil de densification personnelle.
Les traumatismes, stress, drames et autres accidents de la vie relèvent autant d’événements de la vie quotidienne que de situations exceptionnelles comme les catastrophes naturelles, les guerres ou les attentats. En certaines circonstances, l’appareil psychique est débordé par ces événements, une souffrance s’installe, et une aide adaptée est alors nécessaire pour prendre en charge ces « blessures invisibles »
Fondé sur la grande expérience de l’auteur et sur des histoires cliniques, l’ouvrage définit les différents tableaux cliniques (état de stress post-traumatique, harcèlement moral, burn-out, traumatisme sexuel, syndrome de Lazare, résilience…) et les diverses techniques disponibles de prise en charge (défusing, débriefing, psychothérapies, EMDR…) et de prévention
Des exemples concrets présentent enfin les modalités d’action selon les circonstances (prise d’otage, deuil collectif, guerre, catastrophe, camp de réfugiés) et selon le lieu de la prise en charge (institution, travail avec un interprète…)
Inscrit au cœur d’une pratique quotidienne, tout en s’appuyant sur des connaissances théoriques, l’ouvrage s’adresse aux thérapeutes, médecins, psychiatres, psychologues, infirmiers et ą tous les soignants qui accompagnent les personnes touchées par un traumatisme psychique.
Il fallait regrouper les repères de compréhension clinique, éthique, du soin, les référentiels, les outils du quotidien au lit du patient (domicile, service et réanimation), et plus encore... Nous avons plein de surprises à venir. Une première version qui a vocation à la densification par vos propositions d'amélioration, de rectification. Si vous voulez supporter l'application, contactez 360medics, nous irons encore plus vite et plus loin, car ensemble.