Irshaad Vial

Publications (3)8.27 Total impact

• Article: Withholding and withdrawing life-support therapy in an Emergency Department: prospective survey.

  Philippe Le Conte, Denis Baron, David Trewick, Marie Dominique Touzé, Céline Longo, Irshaad Vial, Danielle Yatim, Gille Potel
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  ABSTRACT: Few studies have focused on decisions to withdraw or withhold life-support therapies in the emergency department. Our objectives were to identify clinical situations where life-support was withheld or withdrawn, the criteria used by physicians to justify their decisions, the modalities necessary to implement these decisions, patient disposition, and outcome. Prospective unicenter survey in an Emergency Department of a tertiary care teaching hospital. All non-trauma patients (n=119) for whom a decision to withhold or withdraw life-sustaining treatments was taken between January and September 1998. Choice of criteria justifying the decision to withhold or withdraw life-sustaining treatments, time interval from ED admission to the decision; type of decision implemented, outcome. Fourteen thousand eight hundred and seventy-five non-trauma patients were admitted during the study period, 119 were included, mean age 75+/-13 years. Resuscitation procedures were instituted for 96 (80%) patients before a subsequent decision was taken. Physicians chose on average 6+/-2 items to justify their decision; the principal acute medical disorder and futility of care were the two criteria most often used. Median time interval to reach the decision was 187 min. Withdrawal involved 37% of patients and withholding 63% of patients. The family was involved in the decision-making process in 72% of patients. The median time interval from the decision to death was 16 h (5 min to 140 days). Withdrawing and withholding life-support therapy involved elderly patients with underlying chronic cardiopulmonary disease or metastatic cancer or patients with acute non-treatable illness.
  Intensive Care Medicine 01/2005; 30(12):2216-21. · 5.40 Impact Factor
• Article: Abdominal pain in varicella: an unusual cause of spontaneous splenic rupture.

  Irshaad Vial, M Hamidou, M Coste-Burel, D Baron
  European Journal of Emergency Medicine 07/2004; 11(3):176-7. · 0.90 Impact Factor
• Article: Efficacy of alteplase thrombolysis for ED treatment of pulmonary embolism with shock.

  Philippe Le Conte, Ludovic Huchet, David Trewick, Céline Longo, Irshaad Vial, Eric Batard, Danielle Yatim, Marie Dominique Touzé, Denis Baron
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  ABSTRACT: Our objective was to assess efficacy and tolerance of thrombolysis using 0.6 mg/kg of Alteplase in patients with massive pulmonary embolism defined as the association of a pulmonary embolism with shock. We retrospectively included 21 patients presenting with a massive pulmonary embolism confirmed by either scintigraphy or spiral computed tomography. Patients were treated on the basis of a standard rationale followed by thrombolysis with 0.6 mg/kg Alteplase over a period of 15 minutes. Hospital mortality, vital signs before and 2 hours after thrombolysis, and incidence of hemorrhagic events were recorded. Five patients (23.8%) died, 4 of these deaths occurred during the first 4 hours after hospital admission. Systolic and diastolic blood pressure (Sp02) were significantly improved 2 hours after the beginning of thrombolysis. Five minor hemorrhagic events occurred. This study demonstrates that for patients with pulmonary embolism and shock, a bolus treatment with Alteplase is potentially effective and well tolerated.
  American Journal of Emergency Medicine 10/2003; 21(5):438-40. · 1.98 Impact Factor