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1. ISSN 2222 9442 i WEN 4 ET gt SIMEDITERRANEAN S C JOURNAL OF EMERGENCY MEDICINE ie a d t wd W gt e Jod s Lone w E m s M gt E E F pe A MB Um We m A ae g a n Wm d i n F M s L s gt be D P r 9 4i CR D 4 i ies T gt E d ir p j Ci 1 1 d E E n J 7 gt j E g i 1 4 f P Wound or medical devices protection Secuderm Factors behind delay in final disposition of patients La gangrene diabetique du membre inf rieur Austere remote and disaster medicine Occult elbow fractures in children Intoxication par la chloroquine How to prevent and treat vasovagal syncope at its early stage t er i kd Dt w aUe L E j AEON esuscitation CONA September 2014 N 20 National School for J Emergency Care With the NSEC direct your staff into the right path NSEC offers a wide range of courses accredited by the Lebanese Ministry of Education BLS ALS PBLS APLS e Emergency Medicine Techniques Emergency preparedness e Disaster and Crisis Management Forensic Emergencies ED management e Intensive Care Techniques Combat Medics CLS CMAST Demining Medics Road Safety First Aid for passengers Sport Emergency Medicine Techniques In addition to these standardized courses NSEC c2. Introduction L identification des caract ristiques pid miologiques ainsi que la comparaison des techniques anesth sique des patients pr nsentant une gangr ne du pied diab tique anesth sie g n rale versus anesth sie loco r gionale Mat riel et m thode Etude descriptive r trospective tal e sur l ann e 2013 et r alis e au bloc op ratoire des urgences de l h pital militaire de Rabat Les crit res d inclusion taient un ge de plus de 18 ans et une amputation au niveau du membre inf rieur suite une gangr ne voluant dans un contexte de diab te connu ou inaugural Ont t exclus les dossiers incomplets Diff rents param tres pid miologiques cliniques biologiques et th rapeutiques ont t recueillis Les diff rentes techniques anesth siques utilis es ont t compar es en terme de modifications h modynamiques p ri op ratoires rapidit de r duire l hyperglyc mie survenue de complication post op ratoire court terme recours l analg sie post op ratoire ainsi que la dur e totale d intervention R sultats Durant l ann e 2013 118 patients taient recens s dont 109 taient inclus Lage moyen des patients tait de 58 3 11 ans extr mes 25 86 ans dont 81 6 taient de sexe masculin 40 hommes 9 femmes La gangr ne tait localis e au niveau d un pied 61 5 d un orteil 34 9 d une jambe 2 7 ou d une cuisse 0 996 Les caract ristiques biologiques des patients l
3. HABIB I KHAN I KHAN B FEROZ A IQBAL A Emergency showstopper sactors behind delays in final disposition Med Emergency MJEM 2014 20 9 14 Key words factors delay length of stay emergency department ABSTRACT Introduction Clinical management outcome of emergency patients with delays are directly related to blocked access to the next level of care from emergency department It predicts delay to the definitive procedure plan to manage the patient and is also a marker of hospital functional flaws Objective To study the frequency and associated factor of delays behind final disposition of patients presenting to the Emergency Department of a tertiary care hospital in Pakistan Methods This is comparative cross sectional study conducted at Aga Khan University Hospital Both adult and pediatric patients were included Comparison was done between delayed and non delayed emergency department patients Six hour was taken as cut off SPSS version 19 and MS excel 2010 were used for analysis Results Out of 365 cases 133 36 were pediatric and 232 64 were adults patients There were 184 50 males More than six hour delay was noted in 94 patients 27 Adult patients were delayed more than pediatric patients p lt 0 001 Laboratorial radiological test and generated consults were all found highly significant difference for the delays p lt 0 001 297 8196 were discharged home while 17 596 of them were admitted Discussion Overcr
4. It is often associated with a dislocation of the elbow and the medial epicondyle fracture may be a sign of spontaneously reduced dislocation Conversely in case of an elbow dislocation a medial epicondyle fracture has to be sought Med Emergency MJEM 2014 N 20 CONTINUOUS EDUCATION Figure 1 lateral and AP view of the elbow at birth showing that only the distal humeral metaphysis is ossified Figure 2 lateral and AP view of the elbow at 2 years showing the ossification of the capitellum lS i L Y AC 1 es Ne bes DE Figure 3 lateral and AP view at 4 years showing the ossification of the radial head j a sa uos es Ji f DM d Figure 4 lateral and AP view of the elbow at 6 years showing the ossification of the medial epicondyle Figure 5 lateral and AP view of the elbow at 8 years showing the the ossification of the throchlea 31 CONTINUOUS EDUCATION HOW TO PREVENT AND TREAT VASOVAGAL SYNCOPE AT ITS EARLY STAGE Comment pr venir et traiter un malaise vagal son d but FARROKHI P TABOULET P BOUTMY D E How to prevent and treat vasovagal syncope at its early stage Med Emergency MJEM 2014 20 35 8 Keywords syncope vasovagal emergency care blood donation prevention treatment ABSTRACT Parasympathetic system activation is generally known as the origin of vasovagal syncope As a matter of fact the sympathetic system
5. 4 La s v rit de l infection sera jug e d apr s la pr sente pas de signe de sepsis ni de classification du Consensus International sur le Pied Diab tique d s quilibre m tabolique mais pr sente du Tableau I pronostic du pied mais pas vital 1 parmi les Infection mod r e signes suivants ryth me gt 2 cm autour mise en jeu La gangr ne humide est d finie par la pr sence de tissus 2 die MAE de ne Bi fascia n crotiques noir tres Les l sions sont rapidement volutives P 5 8965 Proton Bares extension aux structures ost o articulaires avec d collement et pus gris tre d odeur naus abonde pouvant z aboutir une d gradation rapide de l tat g n ral avec sepsis Presence d un sepsis ou d instabilit P d s quilibre m tabolique et insuffisance r nale m tabolique fi vre frissons tachycardie Infection s v re hypotension confusion vomissements pronostic vital en Les gangr nes diab tiques sont une cause non n gligeable hyperleucocytose acidose hyperglyc mie jeu d antibioth rapies non justifi es et participent ce titre nyperazot mie l aggravation de la r sistance bact rienne et son extension au moins deux signes parmi au travers des soins 5 La fr quence et la s v rit de ces Eod P 36 eee C igine dans l alt ration des fonctions 4o ence cardiaque 30 matt gangrenes trouvent leur origine aus
6. Emergency MJEM 2014 20 40 3 Mots cl s chloroquine intoxication effet stabilisant de membrane choc arr t cardiaque assistance circulatoire Keywords chloroquine intoxication membrane stabilizing effect shock cardiac arrest extracorporeal life support ABSTRACT Chloroquine poisoning is rare but may be life threatening Toxicity results from membrane stabilizing effect related to the blockage of sodium channels on myocardial contractile cells and conduction tissue Bad prognosticators include the presumed ingested dose gt 4 g the decrease in systolic blood pressure 100 mmHg and the enlargement of QRS gt 0 10 s on the electrocardiogram In the emergency department and even as soon as at the pre hospital scene management relies on tracheal intubation epinephrine and diazepam infusion in severely poisoned patients based on prognosticators in order to prevent the onset of cardiac complications Authors affiliation Correspondent author Bruno MEGARBANE MD PhD R animation M dicale et Toxicologique H pital Lariboisi re INSERM 1144 Universit Paris Diderot 2 Rue Ambroise Par 75010 Paris bruno megarbane wanadoo fr Article history info Category Continuous Education Received July 25 2014 Accepted Aug 6 2014 Conflict of interest statement Pr Bruno M garbane There is no conflict of interest to declare R SUM L intoxication par la chloroquine est rare mais potentiellement grave La s v rit
7. M TOURTIER JP Wound or medical device protection benefits of the waterproof dressing Secuderm Med Emergency MJEM 2014 20 3 8 Mots cl s Secuderm pansement secondaire cicatrisation tanche arm e polyur thane plaie Keywords Secuderm secondary dressing wound healing waterproof army polyurethane wound ABSTRACT Aim The wound is the consequence of an acute skin aggression either limited or spreading sometimes iatrogenic which may be worsened by a delay in care in peculiar circumstances The aim of this study is to present the benefits and give potential indications of a waterproof dressing This dressing guarantees the protection during the healing process and increases the patient s compliance to the treatment of his wounds even in difficult situations Methods We used various dressings or means primary adherent dressings polyurethane film cling film to protect wounds in isolated or precarious care situations but also in a more conventional context Results Secuderm is the only dressing that is waterproof reliable for acute and chronic protection for repeated exposures to water excessive sweating friction of clothing projection or complete immersion under water We report the use of Secuderm in different exemption situations in Guyana during French military missions by the Navy divers in Cameroon for the treatment of Buruli ulcers after arthroscopy to protect medical devices catheters etc on acute w
8. MEILLEURE TECHNIQUE ANESTHESIQUE The gangrene diabetic of the lower limb epidemiology and factors of choice of the best anesthetic Technique DAMGHI N BELKOUCH A SIBOU R NEBHANI T ZIDOUH S BELYAMANI L La gangr ne diab tique du membre inf rieur pid miologie et facteurs de choix de la meilleure technique anesth sique Med Emergency MJEM 2014 20 15 22 Mots cl s gangr ne pied diab tique anesth sie locor gionale anesth sie g n rale amputation Key words gangrene foot diabetic locoregional anesthesia general anesthesia amputation ABSTRACT Objective The identification of the epidemiological characteristics as well as the comparison of the anesthetic techniques of the patients presenting a gangrene of the foot diabetic general anesthesia versus locoregional anesthesia Material and method Descriptive retrospective study spread over the year 2013 and realized in the operating block of the emergencies of the military hospital of Rabat The criteria of inclusion were an age of more than 18 years and an amputation at the level of the lower limb further to a gangrene evolving in a context of known or inaugural diabetes The incomplete files were excluded Various epidemiological clinical biological and therapeutic parameters were collected The various used anesthetic techniques were compared in term of modifications perioperative h modynamiques speed to reduce the hyperglycemia arisen post operative short term comp
9. NEP release whereas the control subjects only had an increase of NEP release This study suggests that mass discharge phenomenon plays an important role in triggering VS EP release Mass discharge increases the ability of the body to perform vigorous muscle activity Cardiovascular signs include tachycardia increased blood pressure vasoconstriction in the gastrointestinal tract and the kidneys and a vasodilatation of the lower limb muscles specific action beta 2 receptor of the EP As a result venous pooling of blood in the lower limbs 10 15 26 decreases the venous return The consequence is an activation of the parasympathetic nervous system known as the reflex of Bezold Jarisch The clinical symptoms are sweating bradycardia hypotension nausea vomiting and consciousness loss The decrease of the blood pressure reduces cerebral blood flow which causes lipothymia and light headedness This phenomenon is termed by certain author as hypotensive functional haemorrhage in spite of the absence of external or internal bleedings haemorrhages 15 Baroreceptors system stimulation has been proposed as hypothesis to explain this reflex 127 The decrease of the venous return is considered as a very important triggering factor not only seen in VS genesis but also in other kinds of syncope i e during pregnancy with the supine inferior vena cava compression 28 30 or in case of intrathoracic pressure elevation linked to paroxysmal coughing
10. activation is the major trigger of vasovagal syncope The association of hyperventilation or hyperexcitability neuromuscular syndrome can also play an important role as a trigger good knowledge of these mechanisms may help to prevent and treat the vasovagal syncope at its early stage The treatment of vagal reaction relies on supine position contractions of the muscles of the lower limbs for about ten minutes and reduction of the ventilation rate Authors affiliation Correspondent author Parviz FARROKHI MD Etablissement Fran ais du Sang d Ile de France Site Saint Louis 38 rue Bichat 75010 Paris France parviz farrokhi gmail com Farrokhi P MD Taboulet P MD Boutmy DE MD PhD 1 Etablissement Fran ais du Sang d Ile de France Site Saint Louis 38 rue Bichat 75010 Paris France 2 H pital Saint Louis Assistance Publique H pitaux de Paris 1 avenue Claude Vellefaux 75010 Paris France Article history info Category Continuous Education Received July 25 2014 Accepted Aug 6 2014 Dr Parviz Farrokhi Conflict of interest statement There is no conflict of interest to dedare Acknowledgement To the staff of Saint Louis Blood Collection Centre R SUM L activation du syst me parasympathique est g n ralement connu comme l origine de la syncope vaso vagale En fait l activation du syst me sympathique est la g chette principal de la syncope vaso vagale L association d une hyperventilation
11. admission taient caract ris es par une hyperleucocytose une hyponatr mie une l g re acidose et une insuffisance r nale La quantit du solut perfus en pr op ratoire tait de 250 132 mL avec administration d un bolus initial de 10 UI d insuline rapide L antibioth rapie tait base d amoxicilline acide clavulanique 66 7 de c fazoline 22 8 d amoxicilline acide clavulanique m tronidazole 6 3 et de m tronidazole seul 4 2 Les techniques anesth siques utilis es taient un bloc plexique 62 2 une rachianesth sie 24 7 une anesth sie locale 8 5 et une anesth sie g n rale 4 6 Ces diff rentes techniques ont t compar es en terme de modifications h modynamiques p ri op ratoires rapidit de r duire l hyperglyc mie survenue de complication post op ratoire court terme recours l analg sie post op ratoire ainsi que la dur e totale d intervention La quantit du solut perfus en perop ratoire tait de 775 409 mL La pr m dication tait faite par le midazolam Les variations h modynamiques taient importantes dans le groupe rachianesth sie et anesth sie locale La r duction de l hyperglyc mie ainsi que la dur e d intervention taient plus importantes dans le groupe anesth sie g n rale Les suites postop ratoires taient marqu es par la survenue d un choc h morragique chez trois malades 3 396 et d un choc septique chez un malade 1 196 Notre tude a montr l ava
12. clinic in an underdeveloped region Figure 1 in an air ambulance setting during a wilderness expedition or wilderness rescue situation during an in flight or space mission emergency or in a disaster L Figure 1 Healthcare clinic in an underdeveloped setting Med Emergency MJEM 2014 N 20 23 CONTINUOUS EDUCATION OCCULT ELBOW FRACTURES IN CHILDREN SOME TIPS AND TRICKS TO READ RADIOGRAPHS COURVOISIER A CALVELLI N BOURGEOIS E EID A GRIFFET J Occult elbow fractures in children some tips and tricks to read radiographs Med Emergency MJEM 2014 20 30 4 Keywords elbow traumatism fracture children ABSTRACT Elbow traumatisms are very common in children X rays play important roles in the diagnosis but are sometimes difficult to read considering the quality the normal variations of bone ossification and the type of fracture The key to a better understanding of these fractures is first to differentiate normality from abnormality The purpose of this report is to provide tricks and tips to help the reader when dealing with a child with an elbow traumatism The real problem is to miss a fracture that would need a surgical treatment Simple geometric constructions and knowledge of the aspect of the different ossification steps of a growing elbow are sufficient But there is no need to do comparative X Rays This report was focused on the X rays but one must not forget the common sense and the clinical examination
13. d pressive depuis deux ann es la suite de plusieurs checs professionnels l admission aux urgences la patiente est calme et parfaitement consciente Sa pression art rielle est 95 50 mmHg sa fr quence cardiaque 110 batt min sa fr quence respiratoire 20 cycles min et sa SpO 97 en air ambiant D s le box d accueil un 40 Med Emergency MJEM 2014 N 20 In dit Un num ro exceptionnel de Soins sur LES INFIRMIERES DANS LA GRANDE GUERRE d couvrir dans le num ro de juin de la revue SOINS 128 pages sur le role des infirmieres durant la Premiere Guerre Mondiale qui ont ceuvr sur tous les fronts pour sauver des vies soulager la douleur et s efforcer de r parer l irr parable tant dans les corps que dans les mes Un num ro hommage ces grandes oubli es de la guerre de 14 18 qui fera date dans la profession 24 articles originaux d une grande richesse avec de nombreuses r f rences bibliographiques Des contributions nationales et internationales Une iconographie riche avec des documents d archives rares BON D CO M MAN D E retourner ou faxer Elsevier Masson Service clients 62 rue Camille Desmoulins 92442 Issy les Moulineaux France T l 01 71 16 55 99 Fax 33 1 71 16 55 77 Contact http em consulte com infos OUI je souhaite commander le n 786 Sp cial de la revue Soins TITRE PRIX UNITAIRE TTC QUANTIT MONTANT A REGLER Num ro sp
14. fr quence respiratoire gt 20 cycles min des polynucl aires neutrophiles particuli rement marqu e en PaCO lt 32 mmH cas d hyperglyc mie prolong e 6 7 dans l anatomie particuli re leucocytose gt 12000 mm ou lt 4000 mm ou 10 de formes immatures du pied 8 qui favorise la diss mination de l infection et dans Table D finition et classification des infections du pied diab tique 3 16 Med Emergency MJEM 2014 N 20 CONTINUOUS EDUCATION AUSTERE REMOTE AND DISASTER MEDICINE KEEPING EVERYBODY SAFE MACIAS D WILLIAMS J Austere remote and disaster medicine keeping everybody safe Med Emergency MJEM 2014 20 23 9 Keywords Wilderness medicine disaster medicine resource limited 7 P S ABSTRACT Medical care in resource limited environments austere settings can occur in the context of a disaster wilderness or a tactical field operation Regardless of the type of environment there are common organizational themes in most successful humanitarian missions that occur in harsh environmental conditions be they natural or man made These principles prioritize the initiation and execution of any given deployment in austere or remote settings diverging from priorities that would occur in a situation where the medical structure is intact and operating well Attention to these priorities not only helps providers with delivering medical care to the needy during a period of resource limitations they als
15. B The second pathway involvement is less common but more striking Hence clinical signs blood pressure fall and bradycardia arise without warnings or delay due to the direct role of the hypothalamic stimulation 26 on both the sympathetic center inhibition and the parasympathetic system activation One could name it the central pathway In all cases they are several associated factors that can be involved The CO is one of the metabolic factors which has potent effect in controlling cerebral blood flow Hyperventilation is a normal response of the body to eliminate an excessive muscular CO production during physical exercise The hyperventilation acts quickly to avoid the hypercapnia high pressure CO or PCO level thus the increase of pH in the blood In the absence of physical effort hyperventilation is also an answer to stress situations In that case this hyperventilation results in hypocapnia and reduction in cerebral blood flow For example a decrease in cerebral tissue PCO about 20 mm Hg normal value is 40 mm Hg reduces about 4096 cerebral blood flow and vice versa 26 The consequences of hyperventilation induced hypocapnia on the cerebral blood flow may increase the drop of this blood flow induced by both the parasympathetic and sympathetic systems 36 Med Emergency MJEM 2014 N 20 CONTINUOUS EDUCATION INTOXICATION PAR LA CHLOROQUINE Chloroquine intoxication MEGARBANE B Intoxication par la chloroquine Med
16. Camille Desmoulins 92442 lesy les Moulineaux Cedex E x X ELSEVIER MASSON SAS soci t par actions simplifi e associ unique au capital social de 47 275 384 Euros Si ge social 62 rue Camille Desmoulins 92130 ISSY LES MOULINEAUX ELSEVIER ACS Nanterre 542 087 031 N TVA intracommunautaire FRO1542037031 Locataire g rant de Soci t d dition de l Association d enseignement m dical des H pitaux de Paris SA MASSON The neW C MAC Monitor Fine Fast Focused oggie petween the two STORZ KARL STORZ ENDOSKOPE THE DIAMOND STANDARD AN 44 11 2013 A LB KARL STORZ GmbH amp Co KG MittelstraBe 8 78532 Tuttlingen Germany Phone 49 0 7461 708 0 Fax 49 0 7461 708 105 E Mail info karlstorz de KARL STORZ Endoskope East Mediterranean and Gulf S A L Block M 3 Floor Beirut Souks Weygand Street 2012 3301 Beirut Lebanon Phone 961 1 999390 Fax 961 1 999391 E mail info karlstorz emg com www karlstorz com RECOMMENDATIONS FOR AUTHORS Med Emergency MJEM The Mediterranean Journal of Emergency Medicine The Journal publishes articles in English and or French pertai ning to Emergency Medicine from its scientific aspect research case studies clinical articles orientation and practical conduct administrative Management and organization of Emergency Me dicine medical legal and social aspects It also accepts articles that deal with prevention of emergencies Although it focus
17. ORT H BON O HERSAN O TRAVERS S BIGNAND M TOURTIER JP Factors behind delay in final disposition of patients from emergency department of a tertiary care center KAZI G SIDDIQUI E HABIB I KHAN I KHAN B FEROZ A IQBAL A Original Articles French 0 0 0 0 00000000000 0 La gangr ne diab tique du membre inf rieur pid miologie et facteurs de choix de la meilleure technique p 15 anesth sique The gangrene diabetic of the lower limb epidemiology and factors of choice of the best anesthetic technique DAMGHI N BELKOUCH A SIBOU R NEBHANI T ZIDOUH S BELYAMANI L Continuous Education Austere remote and disaster medicine keeping everybody safe o D 23 MACIAS D WILLIAMS J Occult elbow fractures in children some tips and tricks to read radiographs sss p 30 COURVOISIER A CALVELLI N BOURGEOIS E EID A GRIFFET J How to prevent and treat vasovagal syncope at its early stage p 3D FARROKHI P TABOULET P BOUTMY DE Continuous Education French Intoxication par la chloroquine E p 40 Chloroquine intoxication M GARBANE B General information Recommendations for authors E p 46 Membership tt D 48 Med Emergency MJEM 2014 N 20 ORIGINAL ARTICLE WOUND OR MEDICAL DEVICE PROTECTION BENEFITS OF THE WATERPROOF DRESSING SECUDERM Protection des plaies ou d un dispositif m dical int r ts du pansement tanche Secuderm LEFORT H BON O HERSAN O TRAVERS S BIGNAND
18. an provide customized courses and workshops to mesh with our customers needs and requirements in their preferable language English Arabic and or French Fanar P O Box 90815 Jdeideh Metn Lebanon T 961 1 888921 Ensec newhealthconcept net Wwww newheathconcept net EDITOR S NOTE When there is a will there is a way MED Emergency MJEM Mediterranean Journal of Emergency Medicine Publication of the Lebanese Resuscitation Council By New Health Concept PO Box 90 815 Jdeideh Lebanon Tel 00961 1 888921 Fax 00 961 1 888922 Email info newhealthconcept net Website www newhealthconcept net a EDITORIAL BOARD EDITOR IN CHIEF Nagi SOUAIBY MANAGING EDITOR Maria FRANGIEH a RESEARCH Abdo KHOURY France Steve PHOTIOU Italy Jean Cyrille PITTELOUD Switzerland CONTINUOUS EDUCATION Elvis CORDIER France Daryl MACIAS USA Karim BEN MILOUD Switzerland INNOVATION EDITING AND TRANSLATION Guillaume ALINIER Qatar UK Karim FARAH Lebanon Hugues LEFORT France ONLINE PUBLICATION AND DESIGN Isma l HSSAIN France Alec KAZANDJIAN Mireille SROUR NURSING Lina AOUN CHOUEIRY Chantal SAADEH KHALIL MIDWIVES Sabine ABOU MALHAM Canada STUDENTS FORUMS AND CONFERENCES Ziad KHOUEIRY France PARAMEDICS AND AMBULANCES Fr d ric HOEPPLI Switzerland Juerg LINIGER Switzerland ADMINISTRATION AND MARKETING Georges KHALIL ALLIANCES Fire Brigade of Paris France Global Network Association
19. avec hyperexcitabilit neuromusculaire peut galement jouer un r le important Une bonne connaissance de ces m canismes peut aider pr venir et traiter la syncope vaso vagale son d but Le traitement de la r action vagale repose sur le d cubitus dorsal des contractions musculaires des membres inf rieurs pendant environ dix minutes et la r duction de la fr quence ventilatoire Med Emergency MJEM 2014 N 20 35 CONTINUOUS EDUCATION INTRODUCTION Syncope is a common problem that occurs in general practice in the emergency room and also before during or after blood donation 1 5 Approximately 1 3 of the emergency admissions to the hospitals and 1 of all hospitalizations 1 6 are related to syncope the majority with vasovagal origin The prognosis is good but this at an extra cost to the public healthcare The aim of this paper is to describe the pathophysiology of the vasovagal syncope also called vagal syncope or VS in order to understand and implement the steps required for its prevention and treatment The main clinical VS symptoms are classically the results of the parasympathetic activation Indeed before parasympathetic activation the sympathetic system stress related activation plays a major role in the VS genesis 7 16 Furthermore the hyperventilation and neuromuscular excitability syndromes 17 23 are sometimes the prodromes of VS and they may warn the clinicians to prevent and treat t
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21. cular Furthermore conflict affected countries where services pertaining to emergency medicine and management are particularly needed yet still understudied Accordingly more studies are required to reflect the true demands and needs in emergency field whether in its technical medical and or managerial aspect to assess what is currently being done and to develop efficient relevant standards As such in MJEM Med Emergency we make sure that we highlight recent concerns and challenges throughout original articles and studies performed in the MENA region We also include research and latest studies performed in high income countries the European and American experience to benefit from their know how Furthermore we reflect findings of research performed in various work environments extreme conditions different target population etc We try to tackle the different aspects of this specialty throughout our enriching original articles continuous education literature review case reports abstracts and relevant news sections Last but not least we support young talents and innovations we follow up and actively take part in relevant conferences and training on a national and international level We strive to exceed our readers expectations Nagi Souaiby MD MPH MHM Chief Editor coven ooo Original Articles Wound or medical device protection benefits of the waterproof dressing Secuderm sss p 3 LEF
22. de cette intoxication est li e l effet stabilisant de membrane qui r sulte du blocage des canaux sodiques la surface des cellules contractiles et du tissu de conduction cardiaque Les facteurs de mauvais pronostic sont la dose suppos e ing r e gt 4 g la baisse de la pression art rielle systolique 100 mmHg et l largissement des complexes QRS sur l lectrocardiogramme gt 0 10 s Aux urgences ou en pr hospitalier la strat gie th rapeutique est bas e sur l intubation trach ale la mise sous adr naline et l administration de diaz pam pr ventivement d s l identification d une forme s v re en se basant sur les facteurs pronostiques et avant la survenue de complications cardiaques L intoxication par la chloroquine Nivaquine Savarine est rare mais potentiellement grave En France la publication dans les ann es 80 du livre Suicide mode d emploi avait popularis l intoxication la chloroquine Depuis cette date les facteurs pronostiques ont t identifi s et la strat gie th rapeutique optimis e Malgr la r duction des prescriptions de chloroquine en raison des r sistances acquises par l agent du paludisme cette intoxication persiste en France avec la facilitation r cente de sa d livrance sans ordonnance sur internet CAS CLINIQUE Une jeune femme de 36 ans est admise au service d accueil des urgences amen e par son compagnon qui l a vu ing rer des m dicaments en exc s 1h30 auparavant Elle est
23. e group spinal anesthesia and local anesthetic The reduction of hyperglycemia as well as the duration of intervention were more important in the group general anesthesia The post operative consequences were marked by the arisen of a hemorrhagic shock at three sick 3 396 and with a toxic shock at a sick person 1 196 Our study showed the advantage to realize plexique blocks compared with the other anesthetic techniques Conclusion Our therapeutic protocol which consists of an adapted hydro electrolytic resuscitation e metabolic preoperative and favors plexiques blocks allowed to reduce the incidence of the hemodynamics peroperative variations and the post operative complications but would require to have patients more important staff and to be compared with other similar studies Authors affiliation Article history info Correspondent author Nada DAMGHI MD Category Original article P le SAMU SMUR SAU CHR Idrissi Received April 14 2014 BP 14020 K nitra Maroc Revised July 24 2014 damghinada hotmail com Accepted Aug 2014 Damghi N MD Belkouch A MD Sibou R MD Nebhani T MD Zidouh S MD Belyamani L MD Conflict of interest statement F 1 P le SAMU SMUR SAU H pital Idrissi CHR K nitra Maroc There is no conflict of interest to declare 2 Service d anesth siologie h pital d instruction militaire Mohamed V Rabat Maroc Med Emergency MJEM 2014 N 20 ORIGINAL ARTICLE R SUM
24. ere is any doubt For example masking the eye region in photographs of patients is inadequate protection of anonymity If identifying characteristics are altered to protect anonymity such as in genetic pedigrees authors should provide assurance that alterations do not distort scientific meaning and editors should so note Statement of Human and Animal Rights When reporting experiments on human subjects authors should indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation institutional and national and with the Helsinki Declaration of 1975 as revised in 2000 5 If doubt exists whether the research was conducted in accordance with the Helsinki Declaration the authors must explain the rationale for their approach and demonstrate that the institutional review body explicitly approved the doubtful aspects of the study When reporting experiments on animals authors should be asked to indicate whether the institutional and national guide for the care and use of laboratory animals was followed International Committee of Medical Journal Editors Uniform Requirements for Manuscripts Submitted to Biomedical Journals February 2006 Med Emergency MJEM 2014 N 20 On the occasion of the Third World Congress of Plastic Surgeon of Lebanese Descent The Euro Mediterranean Council for Burns amp Fire Disasters MBC and The National School for Emer
25. es more on practical issues of emergency medicine the Journal accepts theoretical methodological and analytical articles It is also interested in communications letters commentaries and critiques of issues related to emergency Authors can submit their original articles and the accompanying references to the editor New Health Concept B P 90 815 Jdeideh Lebanon or via email The article should be accompanied by a letter by the author s that clearly states that joint authors of the article are aware of the application to publish and have agreed to allow free accessing of texts by New Health Concept Edition publication Please create a separate file indicating the name of the author for all the photographs tables and graphs you would like to be included in the article and send them to the following address mjem newhealthconcept net All submissions will undergo a preliminary evaluation and an ethical revision by the editorial board to determine whether it will be allowed to appear in the journal Articles that pass this preliminary evaluation will also be anonymously reviewed by two members of a scientific committee Once the article has been approved for publication a biography of 10 lines should be developed MANUSCRIPT PREPARATION Articles are to be submitted in a typewritten format Paragraphs are double spaced Font size should be 12 The submitting author should send his contact details with the article such as telephone number or a
26. gency Care Have the pleasure to invite you to attend the Special Burn session oaturday October 25 2014 Le Royal Palace Hotel Dbaye 11 00 12 00 C r monie officielle Lancement du projet Mise en Place d un Plan Catastrophe National pour la Prise en Charge des Br l s au Liban Projet du Conseil de Recherche de l Universit St Joseph e Introduction et pr sentation du projet Dr Nagi Souaiby Sara Mufarrij Lina Deghaili e Plan Suisse Professeur Wassim Raffoul e Mot de l Ambassadeur Suisse e Mot du Recteur de l USJ e Mot du Ministre de la Sant 12 00 12 30 MBC LECTURE 1 Burn Unit at the Lebanese Hospital Geitawi G GHANIM Lebanon 12 30 13 00 MBC LECTURE 2 Burn Care Program a strategic national public health project W RAFFOUL Switzerland 13 00 13 30 Lunch box 13 30 13 40 Prehospital management of Burns Khoury France 13 40 13 50 Les progr s en br lologie chirurgicale les 50 derni res ann es M Costagliola France 13 50 14 00 Neck Burn Reconstruction M Costagliola France 14 00 14 10 Assessment of airway improvement following neck burn scar contracture o Hayek A El Khatib G Kanaze Lebanon 14 10 14 20 Application Smart Phone Pour Grand Brul s A Khoury France 14 20 14 30 Measures of Intervention in Burn Disasters Preparedness and Crisis Management B Atiyeh S Dibo Lebanon 14 30 14 40 Evolution of biological bandages in burn treatment L A L aurent Applega
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28. he VS Figure 1 o ae oTz GRR IH lt 26 So lt naq aX Figure 1 Triad syndrome PATHOPHYSIOLOGY OF THE VS They are two pathways involved in the VS genesis 24 The major and slower one is the hypothalamic adrenal medullae axis In this case VS occurs about six to ten minutes after triggering factor onset 2425 It could be called the hormonal or peripheral pathway It begins with global sympathetic system activation There are two modes for sympathetic system activation partial and global 26 The partial activation is mediated by the postganglionic sympathetic nerves that release norepinephrine NEP a vasoconstrictive and cardiotonic agent Thus NEP is able to prevent the orthostatic syncope 1 12 The global activation is mediated by the hypothalamus stimulated by stress panic fear or severe pain It induces a global sympathetic activation called mass discharge discharge simultaneous of almost all portions of sympathetic nervous system The adrenal medulla stimulation by postganglionic sympathetic nerves releases large amount of catecholamines about 8096 epinephrine EP and 2096 NEP into circulating blood This activation has almost the same effects as those caused by direct sympathetic stimulation but differs in duration by lasting five to ten times longer According to a study by Sra 14 the patients exhibiting VS six minutes after the starting tilt test had significant increase of the EP and
29. jectif de ce travail est de proposer une m thode de lecture rapide et simple bas e sur des rep res clairs permettant au praticien de d tecter des anomalies l ECG notamment celles pr dictives de probl mes graves et n cessitant une prise en charge imm diate Ce travail est l aboutissement d une revue de la litt rature et des guides pratiques propos s dans le commerce Mais il est surtout le fruit d une pratique quotidienne dans les services des urgences et en pr hospitalier Une approche syst matique est propos e Sont abord s successivement et sous forme de chapitres s par s facilitant la lecture les l ments suivants les pr requis anatomiques et lectro physiologiques l onde P et l espace PR le ORS l onde T les troubles du rythme de la conduction et de la repolarisation les donn es lectriques et quelques pi ges viter Cet ouvrage sera sans doute le livre de chevet de tout professionnel d sireux de mettre profit toutes les informations que la lecture de l ECG peut offrir pour une bonne approche diagnostique Disponible chez Sauramps M dical partir de Novembre Co Edition lt NEW HEALTH Fa medical AS CONCEPT MEDITERRANEAN JOURNAL OF EMERGENCY MEDICINE MED EMERGENCY URGENCE La revue M diterran enne de M decine d Urgence est l un des meilleurs forums d changes entre les professionnels de l urgence ou le haut niveau thique et scientifique des publications va de paire avec
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31. lication appeal in the analgesia operating comment as well as the total duration of intervention Results During year 2013 118 patients were listed among which 109 only included The average age of the patients was 58 3 11 years old extremes 25 86 years among which 81 6 were male 40 men 9 women The gangrene was localized at the level of a foot 61 5 of a toe 34 9 by a leg 2 7 or of a thigh 0 9 The biological characteristics of the patients in the admission were characterized by a hyperleucocytose hyponatremia a light acidose and a renal insufficiency The quantity of the perfused solution in preoperative was 250 132 mL with administration of an initial bolus of 10 UI of fast insulin The antibiotic treatment was with amoxicillin clavulanic acid 66 7 of cefazolin 22 8 of amoxicilline clavulanic acid metronidazol 6 3 and of metronidazol only 4 2 The used anesthetic techniques were a plexique block 62 2 a spinal anesthesia 24 7 a local anesthetic 8 590 and a general anesthesia 4 696 These various techniques were compared in term of modifications perioperative h modynamiques speed to reduce the hyperglycemia arisen post operative short term complication appeal in the analgesia operating comment as well as the total duration of intervention The quantity of the perfusd solution it perop ratoire was 775 409 mL The premedication was made by the midazolam The hemodynamic variations were important in th
32. merus has to almost touch the superior part of the medial epicondyle Figure 11 With these tools we are now able to proceed to the analysis of abnormal X Rays Two important signs need to be sought in all cases of elbow traumatism The first sign is hemarthrosis When there is blood in the joint the capsule is distended On a lateral view the distention of the capsule induces a modification of the position of the fat density triangle at the anterior part of the joint Figure 12 The second sign is the edema On an AP view the soft tissues close to the fracture are filled with hematoma and edema which causes a differentiation of the soft tissues density Figure 13 These two signs are very important in cases of occult fractures We are now armed to describe the different types of fractures of the elbow in children But we will only focus on difficult diagnosis The supracondylar fractures Supracondylar fractures are very frequent Many are very displaced and the diagnosis is easy Two types of supracondylar fracture are difficult to diagnose supracondylar fracture with anterior flexion of the distal fragment and the non or slightly displaced supracondylar fracture in extension Figures 14 15 In these two cases the hemarthrosis sign is positive and on the tip is to use the geometrical constructions The medial epicondyle fracture 2 The medial epicondyle fracture is the second most common fracture after the supracondylar fracture
33. n email address The original text of the article should be sent without illustrations in its original format e g Microsoft Word Pages should be numbered Titles and subtitles of equal importance should be marked identically Abbreviations should be explained when first encountered in the text The articles should not exceed 2500 words or not more than 10 pages Abstracts and Key Words Each article should include an abstract In English and in French for French articles no longer than 300 words Keywords not more than 6 words and the title of the article should also be presented in both languages Text The author needs to respect the following formatting pro cedures when submitting the article Onthe front page the author s name affiliations complete mai ling address telephone number and email address The names and the affiliations of collaborators should be clearly indicated Please ensure that this information is only presented on the front page and does not appear on the other pages of the article Bibliographic References need to appear in order of appea rance in the text They must be identified in the text by Arabic numbers in brackets There should be about 10 30 references They must conform to presentation norms applied in the scien tific editing world Vancouver style Photographs figures graphs and tables these should be sent in separate files and need to be numbered and marked with the author s name and comme
34. ntage de r aliser des blocs plexiques par rapport aux autres techniques anesth siques Conclusion Notre protocole th rapeutique qui consiste en une r animation hydro lectrolytique et m tabolique pr op ratoire adapt es et privil gie les blocs plexiques a permis de r duire l incidence des variations h modynamiques perop ratoires et des complications postop ratoires mais n cessiterait d avoir un effectif plus important de patients et d tre compar d autres tudes similaires INTRODUCTION L infection complique l volution d une plaie chronique du pied Manifestations cliniques de l infection S veit PEDIS diab tique dans 25 des cas en alourdit consid rablement Absence de pus et ou de signes dinflammation Pas d infection la prise en charge et augmente le risque d amputation surtout ne ell Boe N rite d bres infi 2 parmi les signes suivants sont pr sents Pen orsqu elle est associ e a une arterite des membres INITIEUTS augmentation de volume induration ryth m roh n E et ou une ost ite sous jacente 1 2 Le diagnostic de l infection entre 0 5 et 2 cm autour de la l sion sensibilit dad d repose sur la pr sence d au moins deux des signes suivants ou douleur chaleur locale coulement d NE augmentation de volume induration ryth me p ri l sionnel purulent sensibilit locale ou douleur chaleur locale ou pr sence Comme pr c demment le patient ne de pus 3
35. ntary They need to be numbered in chronological ordered when they are to be referred to in the text The term graph table figure photo number x should be used in order to avoid confusion with bibliographical references End notes should be listed separately at the end of the text and not at the end of each page PS It s strongly recommended to add photography of the author who can also allow us to communicate his E mail address 46 For research original articles and review articles authors should clearly note the following If the study was approved by a local or international IRB insti tutional review board a government ministry or a community group The design of a study a randomized controlled trial or an observational study that includes a control group Discuss attempts to limit bias in the article The design of a review formal meta analysis or a systematic review that only includes studies with a control group how the review articles are selected Which statistical tests are used to analyze the data ADDENDUM Conflict of Interest Statement Conflict of interest exists when an author or the author s institution reviewer or editor has financial or personal relationships that inappropriately influence bias his or her actions such relationships are also known as dual commitments competing interests or competing loyalties These relationships vary from those with negligible potential to those wit
36. o can keep a provider teams the public and a patient safe during and after a deployment Authors affiliation Correspondent author Darryl MACIAS MD Department of Emergency Medicine and Emergency Medical Services Academy University of New Mexico School of Medicine Albuquerque NM 87131 USA dmacias salud unm edu Macias D MD Williams Department of Emergency Medicine and Emergency Medical Services Academy University of New Mexico School of Medicine Albuquerque NM 87131 USA Article history info Category Continuous Education Received May 5 2014 Revised June 20 2014 Accepted July 4 2014 Dr Darryl Macias Conflict of interest statement There is no conflict of interest to dedare INTRODUCTION Recent world catastrophic events and humanitarian crises have called for more assistance from relief workers than ever before Physicians and other health care workers desire to answer the call more than ever due to a sense of social responsibility commitment to service and increased educational offerings in humanitarian health 1 However some participants may not comprehend the difficulties inherent in working in austere environments Austere medicine is often used in the context of operational medicine associated with combat hazardous or tactical operations 2 Austere medicine also encompasses resource limited settings where advanced hospital technology is not readily available be it in a health care
37. of Emergency Medicine Global Emergency Medicine Literature Review Lebanese Society for Quality and Patient Safety il ADVISORY COMMITTEE Pierre ABI HANNA Georges ABI SAAD Nayla ABOU MALHAM DOUGHANE Arthur ATCHABAHIAN Omar AYACH Abdelouahab BELLOU Maria Paula GOMEZ Thierry GROS Maurice HADDAD Berthe HACHEM Mohamed HACHELAT Jamil HALABI Chokri HAMOUDA Khalil HELOU Aziz KOLEILAT Bruno MEGARBANE Ahmad OSMAN Alissar RADY Wassim RAFFOUL Sami RICHA Abdul MOHSEN AL SAAWI Karim TAZAROURTE Youri YORDANOV Med Emergency MJEM 2014 N 20 The region faces many challenges crises and disasters either manmade or natural Recently disaster and emergency medicine became a priority for hospitals and other healthcare facilities And in the past years a rapid evolution in emergency medicine has occurred in the region In fact researchers from the US and several European countries are collaborating with their peers from the Middle East and North Africa region to develop new research studies in emergency medicine field gather more comprehensive related data and provide relevant training workshops to hospital and healthcare staff and other relevant stakeholders on the preparedness and management of various emergencies In spite of the humanitarian crisis as well as the political and budgetary constraints the region has much potential for growth and development in the health sector in general and the emergency field in parti
38. ounds or even during patient exposure to a nuclear radiological biological or chemical risk NRBC Discussion To effectively protect a wound is difficult when the human resources and materials are limited An efficient protection of the healing wound allows the resumption of professional social and private activities in a certain comfort Probably the only solution that is currently available Secuderm is a cunning waterproof protection for several days Its indications are multiple whether in the treatment of acute chronic or iatrogenic wounds at the hospital at home in degraded situation or even when exposed to nuclear radiological biological or chemical risk Prospective comparative studies are required Authors affiliation Correspondent author Hugues LEFORT MD Emergency Medical Service Fire Brigade of Paris Paris France 1 place Jules Renard 75017 Paris hdlefort gmail com Lefort H MD Bon O MD Hersan O MD Travers S MD Bignand M MD Tourtier JP MD 1 Pre Hospital Care Department Fire Brigade of Paris France 2 SMPM Paris France Article history info Category Original article Received Nov 21 2013 Revised June 20 2014 bx Accepted July 23 2014 Dr Hugues Lefort Conflict of interest statement There is no conflict of interest to declare Med Emergency MJEM 2014 N 20 3 ORIGINAL ARTICLE EMERGENCY SHOWSTOPPER FACTORS BEHIND DELAYS IN FINAL DISPOSITION KAZI G SIDDIQUI E
39. owding is common in Emergency Department ED and hence the chances of delay in disposition of patients from ED are very high which will ultimately compromise the patient care Reducing the number of comparatively stable patients with effective triaging ED clinics and diverting available resources towards more critical patients can reduce congestion input and throughput Reducing consults and unnecessary investigations with the provision of more experienced physicians amp nurses is an important factor to reduce delays Conclusion Extended length of stay in ED may exceed the potential capability to deliver quality care within appropriate time frame this may lead to drastic decrease in patient and family satisfaction leading to compromised clinical care Authors affiliation Correspondent author Sayyeda GHAZALA IRFAN KAZI MD Assistant Professor Department of Emergency Medicine Aga Khan University Pakistan ghazala kazi aku edu Kazi G MD Siddiqui E MD Habib I MD Khan I MD Khan B MD Feroz A MS Iqbal A Department of Emergency Medicine Aga Khan University Article history info Category Original article Received April 9 2014 Revised June 18 2014 Accepted July 28 2014 Dr Ghazala Kaz Conflict of interest statement The authors declare no conflict of interest Med Emergency MJEM 2014 N 20 ORIGINAL ARTICLE LA GANGRENE DIABETIQUE DU MEMBRE INFERIEUR EPIDEMIOLOGIE ET FACTEURS DE CHOIX DE LA
40. s of bone ossification of the elbow need to be understood At birth only the distal humeral metaphysis is ossified Figure 1 Then the elbow ossification progressively appears at 2 years the capitellum is ossified Figure 2 at 4 years it is the radial head Figure 3 at 6 years it is the medial epicondyle Figure 4 at 8 30 Med Emergency MJEM 2014 N 20 years it is the trochlea Figure 5 at 10 years it is the olecranon Figure 6 and finally at 12 years it is the lateral epicondyle Figure 7 Different lines and geometrical constructions on the X ray may also help to detect an anomaly The most important features are described hereafter On the lateral view the anterior flexion of the distal humerus is between 30 and 40 Figure 8 The Storen construction whatever the view on the X rays the axis of the radial diaphysis crosses the center of the capitellum this point is very important for the diagnostic of dislocation of the radial head Figure 9 On the lateral view the line of the anterior cortex of the humeral diaphysis crosses the middle of the capitellum Figure 8 The angle of Baumann on an AP view it is the angle between the line which passes by the middle of the humeral diaphysis and the one that passes through the growth plate at superior part of the capitellum The angle is normally 72 5 Figure 10 On an AP view the line who is in the prolongation of the medial cortex of the hu
41. te C Scaleea N Hirt Burri A de Buys Roessingh Y A Que P Jafari W Raffoul Switzerland 14 40 15 00 Discussion 15 00 15 30 ROUND TABLE W Raffoul M Costagliola e Wound cleansing topical antiseptics and wound healing F Chahine B Atiyeh o Hayek Lebanon Effect of Silver on burn wound infection control and healing Review of the literature J Baroud B Atiyeh M Costagliola S Hayek S Dibo Lebanon France New technologies for burn wound closure and healing Review of the literature F Chahine B Atiyeh S Hayek S W Gunn Lebanon 15 30 17 00 WORKSHOP on Suturing techniques N Souaiby Lebanon W Raffoul Switzerland For information and registration NSEC Tel Fax 961 1 888921 Email nsec newhealthconcept net Website www newhealthconcept net Trust amp Traders Intl Tel Fax 961 1 333900 Th 961 1 333130 t961 333730 r i o a e National School for Emergency Care o OF p ie As MEET e Email Lspras2014 trust traders com Website www trust traders com The Advertising Organizations Soins page 44 Karl Storz page 45 Special Burn session page 47 Med Emergency MJEM cover page 3 E Nen Health E EDITOR IN CHIEF AND DIRECTOR ew Health Concept back cover mi Nagi SOUAIBY MANAGING EDITOR Maria FRANGIEH Hi EXECUTIVE BOARD MEDITERRANEAN JOURNAL OF EMERGENCY MEDICINE Ismael HSSAIN Abdo KHOURY ONLINE SUBSCRIPTION 4lssues 8 Issues PUE http
42. to orientate the diagnosis Finally in cases where the X ray is thought to be normal a cast immobilization and evaluation 10 days after the traumatism is necessary Authors affiliation Correspondent author Aur lien COURVOISIER MD Pediatric Orthopedic Department H pital Couple Enfant Grenoble University Hospital Joseph Fourier University BP 217 38043 Grenoble Cedex 09 France acourvoisier chu grenoble fr Courvoisier A MD PhD Calvelli N MD Bourgeois E MD MSc Eid A MD Griffet J MD PhD Pediatric Orthopedic Department H pital Couple Enfant Grenoble University Hospital Joseph Fourier University France f A Dr Aur lien Courvoisier Article history info Category Continuous Education Received Jan 17 2014 Revised Mars 13 2014 Accepted July 24 2014 Conflict of interest statement There is no conflict of interest to declare INTRODUCTION Elbow traumatisms are very common in children X rays play important roles in the diagnosis but are sometimes difficult to read considering the quality the normal variations of bone ossification and the type of fracture The key to a better understanding of these fractures is first to differentiate normality from abnormality The purpose of this report is to provide tricks and tips to help the reader when dealing with a child with an elbow traumatism FIRST LET US DESCRIBE THE NORMALITY 1 From birth to skeletal maturity X ray changes and normal variation
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