[show abstract][hide abstract] ABSTRACT: INTRODUCTION: Hypothermia is common in trauma victims and is associated with an increase in mortality. Its causes are not well understood. Our objective was to identify the factors influencing onset of hypothermia during prehospital care of trauma victims. METHODS: Multicenter, prospective, open, observational study in a prehospital setting. Trauma victims, over 18 years old, receiving care from emergency medical services (EMS) and transported to hospital in a medically staffed mobile unit. Study variables included: demographics and morphological traits, nature and circumstances of the accident, victim's presentation (trapped, seated or lying down, on the ground, unclothed, wet or covered by a blanket), environmental conditions (wind, rain, ground temperature and air temperature on site and in mobile unit), clinical factors, Revised Trauma Score (RTS), tympanic temperature, care provided (including warming, drugs administered, infusion fluid temperature and volume), and EMS and hospital arrival times. RESULTS: 448 patients included. Hypothermia (< 35degreesC) on hospital arrival was present in 64/448 patients (14%). Significant factors associated with absence of hypothermia in a multivariate analysis were RTS: Odds Ratio: 1.68(1.29-2.20) ; no intubation: 4.23(95%CI 1.62-11.02) ; infusion fluid temperature: 1.17 (1.05-1.30) ; mobile unit temperature: 1.20(1.04-1.38) ; patient not unclothed: 0.40(0.18-0.90) ; and no head injury: 0.36(0.16-0.83). CONCLUSIONS: The key risk factor for the onset of hypothermia was the severity of injury but environmental conditions and the medical care provided by EMS were also significant factors. Changes in practice could help reduce the impact of factors such as infusion fluid temperature and mobile unit temperature.
Critical care (London, England) 07/2012; 16(4):R142. · 4.72 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate the use of antidotal therapy in patients with an elevated digitalis concentration following chronic or acute exposure.
Retrospective review of patient records over 2 years in 20 city hospitals in France.
Overall 838 patients with an elevated serum digitalis concentration (digoxin > 1.95ng /ml or digitoxin > 23ng /ml) were included in the study. Of these, 67 (8%) had received antidotal therapy with Fab fragments.
The relationships between previously reported prognostic criteria and use of antidotal therapy were investigated. We identified five independent factors that were associated with the use of antidotal therapy: acute overdose (OR 15.74), Fab fragment availability in the hospital (11.06), serum potassium (1.81), and heart rate (0.96). Mortality was significantly lower in Fab-treated (6%, 4/67) than untreated patients (15%, 117/770).
Antidotal therapy is underused in patients with an elevated digitalis concentration especially in patients with chronic digitalis exposure. These patients in our series presented a higher mortality rate than patients with acute poisoning. Although they were older and tended to have a history of cardiac disease, they did not differ from patients with acute poisoning with regard to the main severity criteria and prognostic factors. The use of identical criteria for antidotal treatment after acute and chronic poisoning should help optimize outcomes. Fab fragment availability is insufficient in France but ranks only second after type of poisoning (acute or chronic) in the multivariate association with Fab treatment.
Intensive Care Medicine 04/2008; 34(8):1448-53. · 5.26 Impact Factor