Revue médicale suisse
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In case of chest trauma, the physician must always carefully evaluate the following parameters before to consider the case as uncomplicated (TTS): 1) the speed and circumstances of the accident; 2) the localization and the intensity of the pain; and 3) the presence of signs of respiratory failure and/or haemodynamic instability. Among patients aged greater than 65, the number of ribs fractured can predict mortality. Patients presenting with TTS, can be discharged from the hospital, provided they are prescribed with adequate analgesic medication and basic physiotherapy exercises, followed by a medical check-up after a five-day period.
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The use of non invasive ventilation (NIV) in the emergency setting to treat acute respiratory failure (ARF) has received much attention. To date, large studies support the early administration of continuous positive airway pressure (CPAP) in patients with cardiogenic acute pulmonary edema; and 2) non-invasive positive pressure ventilation (NPPV) for exacerbations of chronic obstructive pulmonary disease (COPD). NIV could also be useful in other types of ARF, but its success rate is dependent on the cause of ARF and patient's characteristics. Use of NIV in the emergency setting should take into account validated indications and local expertise of the nursing staff to minimize the risk of complications.