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.
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The treatment of agitation in the emergency room is a subject regularly treated in different studies and conferences because of the diagnosis difficulties and the psychological impact on medical teams. Differential diagnosis includes organic, toxic and psychiatric causes. ⋯ Combination of drugs is not to be recommanded. Side effects of current medication are to be well known, that's why only a small number of molecules are to be used, after controlled studies.
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Revue médicale suisse · Jun 2005
Review[Complexity and physiology of the analgesic effects of opioids].
Nowadays, it is considered that clinical pain is not only a reflexion of the nociceptive stimulus intensity, but is to a large extent the expression of neural plasticity including both peripheral and central sensitization. N-Methyl-D-aspartate receptors (NMDA-Rs) play a critical role in the central pain sensitization process leading to exaggerated pain and chronic pain. Although opioids are unsurpassed analgesics, we observed that opioids induced delayed and sustained NMDA-related hyperalgesia after an initial analgesia suggesting a pain sensibilisation process. It is shown that NMDA receptor antagonists and specific diets able to negatively modulate NR2B subunit containing NMDA receptors prevented abnormal pain hypersensitivity, partially reversed chronic pain and restored the opioid effectiveness on opioid-resistant pain models.