Papers by Laurent Domanski
Background
Improving access to thrombolytic therapy for patients with ischemic stroke is challeng... more Background
Improving access to thrombolytic therapy for patients with ischemic stroke is challenging. We assessed a prehospital process based on firemen rescuers under strict medical direction, aimed at facilitating thrombolysis of eligible patients.
Methods
This was a prospective observational study conducted over 4 months in Paris, France. Prehospital patients with suspected stroke were included after phone consultation with a physician. If the time since the onset of symptoms was less than 6 hours, patients were transported directly to a neurovascular unit (NVU), if symptom onset was over 6 hours ago; they were transported to an emergency department. Confirmation of stroke diagnosis, the rate of thrombolysis, and the time intervals between the call and hospital arrival and imaging were assessed. Comparison used Fisher's exact test.
Results
Of the 271 patients transported to an NVU, 218 were diagnosed with a stroke (166 with ischemic stroke), 69 received thrombolytic therapy, and the mean stroke-thrombolysis interval was 150 minutes. Over 64 patients admitted to ED, 36 patients suffered a stroke (ischaemic: 24). None were thrombolysed. Globally, 36% of ischaemic strokes were thrombolysed (27% of all strokes diagnosed). The mean interval call-hospital was 65 min (ED vs NVU: p=0.61). The interval call-imaging was 202 min [IQR: 105.5-254.5] for ED and 92 min [IQR: 77 116] for NVU (p<0.001).
Conclusions
The prehospital management of stroke by rescuers, under strict medical direction, seemed to be feasible and effective for selection of patients suffering from stroke in an urban environment, and may improve the access to thrombolysis.
![Research paper thumbnail of [Penetrating neck injuries: Importance of one systematic clinical examination associated with a MDCT angiography.]](https://attachments.academia-assets.com/36350507/thumbnails/1.jpg)
Evaluer et prendre en charge en urgence un patient victime d’une plaie pénétrante du cou constitu... more Evaluer et prendre en charge en urgence un patient victime d’une plaie pénétrante du cou constitue un réel défi pour les équipes médicales préhospitalières et intra hospitalières. Ceci semble vrai aussi bien en France qu’en Europe où le niveau d’expérience par centre et par médecin reste faible. La seule étude Européenne publiée à ce jour a objectivé une incidence de 1,3 pour 100 000 habitants par an. Ceci contraste avec l’expérience acquise par d’autres équipes Nord-Américaines (Los Angeles) ou Sud-Africaines (Johannesburg) qui ont publié des séries de traumatisme cervical pénétrant supérieures à 200 patients par an et par site.
Nous rapportons ici l’observation d’un adolescent âgé de 13 ans (172 cm pour 64 Kgs), sans antécédent particulier, pris en charge par une équipe médicale préhospitalière 25 minutes après avoir été poignardé à son domicile, au décours d’une rixe familiale.
Nous proposons un grille systématique pour l'examen initial et répété au cours de la prise en charge, la VPP de l'examen clinique étant proche de 100% avec cet outil au regard des données de la littérature.
La cervicotomie exploratrice n'est ainsi plus systématique.
Ulnar, median and radial nerves blocks are techniques used for managing hand traumas in the emerg... more Ulnar, median and radial nerves blocks are techniques used for managing hand traumas in the emergency room such as fractures, dislocations, lacerations and pain. Using those blocks will in most cases allow the emergency treatment of hand trauma without necessarily using neurostimulation nor ultrasound: it consists of injecting a sufficient amount of xylocaine near the nerve to allow it to diffuse safely causing the blockade. In France, and since 2002, the French Society of Anesthesia and Reanimation (SFAR), and the Service d’Aide Médicale Urgentes (SAMU) in addition to the French Society of Emergency Medicine (SFMU) allows emergency physicians to practice LocoRegional Anesthesia: in other words, the application of locoregional anesthesia by. The updated recommendations of 2010 by these societies suggest the spread of local and regional anesthesia in emergency medicine. The aim of this work is to describe local and regional anesthesia of the wrist.
Ultrasound has been used in the field and in emergency departments for more than two decades. In ... more Ultrasound has been used in the field and in emergency departments for more than two decades. In a military setting, its use has grown rapidly as it has gained widespread acceptance among emergency physicians and as the range of diagnostic and triage applications has continued to expand. Technological changes have enabled ultrasound devices to become accessible to general practitioners (GP), and it could be of particular interest for military GPs in isolated environments. We have investigated both the training of French military GPs in the area of ultrasonography and the use of ultrasound devices, in daily practice and abroad, in isolated military settings.
In 2011, a questionnaire was sent to all 147 in-the-field GPs of the French southeast regional military health service. The questionnaire evaluated the training of military GPs in ultrasonography, the use of ultrasound in France in daily practice, and during military operations in isolated environments abroad during 2010.
The response rate was 52%. On the one hand, half the responding GPs had been specially trained in ultrasound, mainly (97%) in military institutes. On the other hand, only a quarter of doctors used ultrasound in daily practice. Among those GPs performing ultrasound examinations in France, 75% used it in 2010 during isolated operations abroad. Ultrasound examinations performed in such an austere environment were retrospectively declared useful to guide clinical reasoning (41% of examinations carried out), diagnosis (21%) and decision making as regards evacuation (11%).
The challenge for the future is to make ultrasound courses mandatory for all military GPs going on overseas operations, to develop daily practice, and to investigate effective triage systems, combining both ultrasound imagery and physical examination.
First responders are sometimes confronted with external uncontrolled haemorrhage despite compress... more First responders are sometimes confronted with external uncontrolled haemorrhage despite compression, bandages, and tourniquets. Several topical haemostatic agents were developed to try to face these situations. Their application was mainly described and studied in military environment. We report the case of a worker victim of an accident of construction site with hemorrhagic perineal trauma for whom the use of a haemostatic bandage QuikClot ACS+™ (Z-Medica) seemed to us particularly useful in prehospital setting.
Les secours médicaux préhospitaliers sont parfois confrontés à des saignements externes difficile... more Les secours médicaux préhospitaliers sont parfois confrontés à des saignements externes difficilement maîtrisables par les moyens habituels (compression, pansements compressifs, garrot…). De nombreux pansements imprégnés de produits hémostatiques ont été développés depuis une dizaine d’années pour tenter de faire face à ces situations. Leur emploi a principalement été décrit et étudié en milieu militaire pour des blessures de guerre. Nous rapportons le cas d’un ouvrier victime d’un accident de chantier avec délabrement périnéal hémorragique pour qui l’utilisation d’un pansement hémostatique QuikClot ACS+TM (Z-Medica) nous a semblé particulièrement utile en préhospitalier.
First responders are sometimes confronted with external uncontrolled hemorrhage despite compression, bandages, and tourniquets. Several topical haemostatic agent were developed to try to face these situations. Their application was mainly described and studied in military environment. We report the case of a worker victim of an accident of construction site with hemorrhagic périnéal trauma for whom the use of a haemostatic bandage QuikClot ACS+TM (Z-Medica) seemed to us particularly useful in prehospital setting.
Les ruptures du tendon distal sont des pathologies rares mais non exceptionnelles et probablement... more Les ruptures du tendon distal sont des pathologies rares mais non exceptionnelles et probablement sous diagnostiquées. Cliniquement les lésions graves du tendon distal du grand pectoral peuvent entrainer des modifications de conformation du creux axillaire dont la compréhension nécessite une connaissance parfaite de l’anatomie du tendon. A travers notre expérience de trois cas, nous présentons dans cet article les modalités précises de l’inspection du grand pectoral et expliquons les modifications parfois surprenantes de conformation de la paroi antérieure du creux axillaire. Classiquement, sont considérées comme chirurgicales uniquement les ruptures totales ou subtotales. Il nous apparait plus juste de décrire des ruptures des ruptures totales, des ruptures partielles graves et des ruptures partielles bénignes. Comme dans la majorité des ruptures tendineuses, le diagnostic est essentiellement clinique et repose principalement sur l’inspection du creux axillaire. Une inspection bien menée, en respectant un certain délai après l’évènement, pourrait permettre de classer les ruptures dans ces trois catégories sans avoir à multiplier les examens complémentaires. Cette attitude facilite ainsi la prise en charge ultérieure.
The Pectoralis Major tendon tears are rare pathologies but not exceptional and probably under diagnosed. Clinically, severe lesions of the Pectoralis Major’s tendon can cause conformational changes of the fossa axillaris whose for understanding requires a perfect knowledge of the tendon’s anatomy. Through our three cases experience, we present in this article the detailed methods of the inspection of the Pectoralis Major and explain the sometimes-surprising modifications of the fossa axillaris’ anterior wall conformation. While traditionally, only total or subtotal tears are considered as surgical, it appears more pertinent to describe total rupture, major partial tears and minor partial tears. As in the majority of tendinous ruptures, the diagnosis is mainly clinical and based primarily on the inspection of the fossa axillaris. A well- conducted inspection, while respecting a delayed time after the event, could help to classify the tears in these three categories without multiplying investigations. This attitude could have significant impacts and facilitate the following management
Just have a look to the file ;-)
Air Med, Nov 2014
Objectives: The aim of this study was to evaluate the capacity of a traditional stethoscope versu... more Objectives: The aim of this study was to evaluate the capacity of a traditional stethoscope versus an electronically amplified one (expected to reduce background and ambient noise) to assess heart and respiratory sounds during medical transport. Materials and Methods: It was a prospective, double-blinded, ran-domized performed study. One traditional stethoscope (Littmann Cardiology III; 3M, St Paul, MN) and 1 electronically amplified stetho-scope (Littmann 3200, 3M) were used for our tests. Heart and lung auscultation during real medical evacuations aboard a medically configured Falcon 50 aircrafts were studied. The quality of ausculta-tion was ranged using a numeric rating scale from 0 to 10 (0 corre-sponding to "I hear nothing" and 10 to "I hear perfectly"). Data collected were compared using a t-test for paired values. Results: A total of 40 comparative evaluations were performed. For cardiac auscultation, the value of the rating scale was 4.53 Ϯ 1.91 and 7.18 Ϯ 1.88 for the traditional and amplified stethoscope, respec-tively (paired t-test: P Ͻ .0001). For respiratory sounds, quality of aus-cultation was estimated at 3.1 Ϯ 1.95 for a traditional stethoscope and 5.10 Ϯ 2.13 for the amplified one (paired t-test: P Ͻ .0001). Conclusions: This study showed that practitioners would be bet-ter helped in hearing cardiac and respiratory sounds with an elec-tronically amplified stethoscope than with a traditional one during air medical transport in a medically configured Falcon 50 aircraft. Medical air evacuations occur in high ambient noise envi-ronments compromising the use of the traditional stethoscope and thus inhibiting the monitoring of patients, 1-3 which must actually be increased because of specific complications during air travel such as worsening tension pneumothorax or mis-placement of the endotracheal tube. Actually, electronic auscultation appears to be a promising practice based on several technologies used to minimize background interferences and at the same time improve the signal-to-noise ratio. The aim of this study is to evaluate the effectiveness of a traditional and an electronically amplified stethoscope during medical air evacuations. Methods A previous study performed during real medical evacua-tions aboard a Falcon 50 or 900 compared a traditional stethoscope (Littmann Cardiology III; 3M, St Paul, MN) with an electronically amplified stethoscope (Littmann 3100, 3M). There were no significant differences concerning pulmonary auscultation. 4 Using the same protocol, we compared an elec-tronically amplified stethoscope of the most recent generation (ie, Littmann 3200, 3M) with a high-quality traditional stethoscope (Littmann Cardiology III). This double-blinded, prospective study achieved over a period of 12 months (June 2010-May 2011) compared a widely used conventional stethoscope (Littmann Cardiology III) with a recently available electronic stethoscope (Littmann Electronic Stethoscope, Model 3200). It was executed during medical evacuations aboard a Falcon in partnership with Villacoublay Air Base Number 107. Consenting physicians, all experienced in medical air trans-port, held the following posts: general practitioners in the French Air Forces and anesthetist resuscitators from 3 French hospitals (Val-de-Grâce Hospital, Paris; Percy Hospital, Clamart; and Bégin Hospital, Saint-Mandé). Participants were asked to evaluate the 2 types of stetho-scope on patients during real medical air evacuations aboard a medically configured Falcon 50 at a standard altitude (10,000 m/32,800 ft). Measurements of ambient noise levels were taken during the flight. All patients were transported for medical reasons. They were either unconscious or blinded with a mask during the auscultation (after obtaining individ-ual agreement to participate in this study when possible).
JEMS : a journal of emergency medical services, 2004
The family had gone to bed only two hours before the fire started.
Soins. Chirurgie
The army nurses of the Paris Fire Brigade serve the population of Paris and three adjacent depart... more The army nurses of the Paris Fire Brigade serve the population of Paris and three adjacent departments. They receive induction as well as continuous training and work within the mobile pre-hospital medical teams. In addition to their day-to-day support of firefighters, they train, teach and participate in clinical research and development. Les infirmiers militaires de la Brigade de sapeurs-pompiers de Paris s’engagent au quotidien au service de la population de Paris et des trois départements limitrophes. Recevant une formation initiale et continue, ils travaillent au sein d’équipes médicales mobiles préhospitalières. Ils assurent aussi le soutien des pompiers au quotidien, ont des missions de formation et d’enseignement, et participent à la recherche clinique.
Soins; la revue de référence infirmière, 2014
The army nurses of the Paris Fire Brigade serve the population of Paris and three adjacent depart... more The army nurses of the Paris Fire Brigade serve the population of Paris and three adjacent departments. They receive induction as well as continuous training and work within the mobile pre-hospital medical teams. In addition to their day-to-day support of firefighters, they train, teach and participate in clinical research and development.
Soins; la revue de référence infirmière, 2014
Following the sanitary disaster which occurred during the first months of First Word War, the Fre... more Following the sanitary disaster which occurred during the first months of First Word War, the French Military Health System has structured itself. Focus was made on effective surgical sorting for stabilization aids before evacuation. The functional prognosis of the war injured individual as his survival has been significantly improved. We report nurses' testimonies, for some unpublished yet: challenging aids, especially wounds.
Soins; la revue de référence infirmière, 2014
The First World War because of the use of new weapons, injured more than 3 500 000 people (500 00... more The First World War because of the use of new weapons, injured more than 3 500 000 people (500 000 in the face), more than diseases (tuberculosis, typhoid fever, etc.) or even weather circumstances. The healing of the war wounds through surgery undertook a significant evolution thanks to the use of asepsis and antiseptics. Mortality go down, opening the way to the physical and psychological rehabilitation of those injured by the war.
Annales françaises d'anesthèsie et de rèanimation, 2014
The journal of trauma and acute care surgery, 2012
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Papers by Laurent Domanski
Improving access to thrombolytic therapy for patients with ischemic stroke is challenging. We assessed a prehospital process based on firemen rescuers under strict medical direction, aimed at facilitating thrombolysis of eligible patients.
Methods
This was a prospective observational study conducted over 4 months in Paris, France. Prehospital patients with suspected stroke were included after phone consultation with a physician. If the time since the onset of symptoms was less than 6 hours, patients were transported directly to a neurovascular unit (NVU), if symptom onset was over 6 hours ago; they were transported to an emergency department. Confirmation of stroke diagnosis, the rate of thrombolysis, and the time intervals between the call and hospital arrival and imaging were assessed. Comparison used Fisher's exact test.
Results
Of the 271 patients transported to an NVU, 218 were diagnosed with a stroke (166 with ischemic stroke), 69 received thrombolytic therapy, and the mean stroke-thrombolysis interval was 150 minutes. Over 64 patients admitted to ED, 36 patients suffered a stroke (ischaemic: 24). None were thrombolysed. Globally, 36% of ischaemic strokes were thrombolysed (27% of all strokes diagnosed). The mean interval call-hospital was 65 min (ED vs NVU: p=0.61). The interval call-imaging was 202 min [IQR: 105.5-254.5] for ED and 92 min [IQR: 77 116] for NVU (p<0.001).
Conclusions
The prehospital management of stroke by rescuers, under strict medical direction, seemed to be feasible and effective for selection of patients suffering from stroke in an urban environment, and may improve the access to thrombolysis.
Nous rapportons ici l’observation d’un adolescent âgé de 13 ans (172 cm pour 64 Kgs), sans antécédent particulier, pris en charge par une équipe médicale préhospitalière 25 minutes après avoir été poignardé à son domicile, au décours d’une rixe familiale.
Nous proposons un grille systématique pour l'examen initial et répété au cours de la prise en charge, la VPP de l'examen clinique étant proche de 100% avec cet outil au regard des données de la littérature.
La cervicotomie exploratrice n'est ainsi plus systématique.
In 2011, a questionnaire was sent to all 147 in-the-field GPs of the French southeast regional military health service. The questionnaire evaluated the training of military GPs in ultrasonography, the use of ultrasound in France in daily practice, and during military operations in isolated environments abroad during 2010.
The response rate was 52%. On the one hand, half the responding GPs had been specially trained in ultrasound, mainly (97%) in military institutes. On the other hand, only a quarter of doctors used ultrasound in daily practice. Among those GPs performing ultrasound examinations in France, 75% used it in 2010 during isolated operations abroad. Ultrasound examinations performed in such an austere environment were retrospectively declared useful to guide clinical reasoning (41% of examinations carried out), diagnosis (21%) and decision making as regards evacuation (11%).
The challenge for the future is to make ultrasound courses mandatory for all military GPs going on overseas operations, to develop daily practice, and to investigate effective triage systems, combining both ultrasound imagery and physical examination.
First responders are sometimes confronted with external uncontrolled hemorrhage despite compression, bandages, and tourniquets. Several topical haemostatic agent were developed to try to face these situations. Their application was mainly described and studied in military environment. We report the case of a worker victim of an accident of construction site with hemorrhagic périnéal trauma for whom the use of a haemostatic bandage QuikClot ACS+TM (Z-Medica) seemed to us particularly useful in prehospital setting.
The Pectoralis Major tendon tears are rare pathologies but not exceptional and probably under diagnosed. Clinically, severe lesions of the Pectoralis Major’s tendon can cause conformational changes of the fossa axillaris whose for understanding requires a perfect knowledge of the tendon’s anatomy. Through our three cases experience, we present in this article the detailed methods of the inspection of the Pectoralis Major and explain the sometimes-surprising modifications of the fossa axillaris’ anterior wall conformation. While traditionally, only total or subtotal tears are considered as surgical, it appears more pertinent to describe total rupture, major partial tears and minor partial tears. As in the majority of tendinous ruptures, the diagnosis is mainly clinical and based primarily on the inspection of the fossa axillaris. A well- conducted inspection, while respecting a delayed time after the event, could help to classify the tears in these three categories without multiplying investigations. This attitude could have significant impacts and facilitate the following management
Improving access to thrombolytic therapy for patients with ischemic stroke is challenging. We assessed a prehospital process based on firemen rescuers under strict medical direction, aimed at facilitating thrombolysis of eligible patients.
Methods
This was a prospective observational study conducted over 4 months in Paris, France. Prehospital patients with suspected stroke were included after phone consultation with a physician. If the time since the onset of symptoms was less than 6 hours, patients were transported directly to a neurovascular unit (NVU), if symptom onset was over 6 hours ago; they were transported to an emergency department. Confirmation of stroke diagnosis, the rate of thrombolysis, and the time intervals between the call and hospital arrival and imaging were assessed. Comparison used Fisher's exact test.
Results
Of the 271 patients transported to an NVU, 218 were diagnosed with a stroke (166 with ischemic stroke), 69 received thrombolytic therapy, and the mean stroke-thrombolysis interval was 150 minutes. Over 64 patients admitted to ED, 36 patients suffered a stroke (ischaemic: 24). None were thrombolysed. Globally, 36% of ischaemic strokes were thrombolysed (27% of all strokes diagnosed). The mean interval call-hospital was 65 min (ED vs NVU: p=0.61). The interval call-imaging was 202 min [IQR: 105.5-254.5] for ED and 92 min [IQR: 77 116] for NVU (p<0.001).
Conclusions
The prehospital management of stroke by rescuers, under strict medical direction, seemed to be feasible and effective for selection of patients suffering from stroke in an urban environment, and may improve the access to thrombolysis.
Nous rapportons ici l’observation d’un adolescent âgé de 13 ans (172 cm pour 64 Kgs), sans antécédent particulier, pris en charge par une équipe médicale préhospitalière 25 minutes après avoir été poignardé à son domicile, au décours d’une rixe familiale.
Nous proposons un grille systématique pour l'examen initial et répété au cours de la prise en charge, la VPP de l'examen clinique étant proche de 100% avec cet outil au regard des données de la littérature.
La cervicotomie exploratrice n'est ainsi plus systématique.
In 2011, a questionnaire was sent to all 147 in-the-field GPs of the French southeast regional military health service. The questionnaire evaluated the training of military GPs in ultrasonography, the use of ultrasound in France in daily practice, and during military operations in isolated environments abroad during 2010.
The response rate was 52%. On the one hand, half the responding GPs had been specially trained in ultrasound, mainly (97%) in military institutes. On the other hand, only a quarter of doctors used ultrasound in daily practice. Among those GPs performing ultrasound examinations in France, 75% used it in 2010 during isolated operations abroad. Ultrasound examinations performed in such an austere environment were retrospectively declared useful to guide clinical reasoning (41% of examinations carried out), diagnosis (21%) and decision making as regards evacuation (11%).
The challenge for the future is to make ultrasound courses mandatory for all military GPs going on overseas operations, to develop daily practice, and to investigate effective triage systems, combining both ultrasound imagery and physical examination.
First responders are sometimes confronted with external uncontrolled hemorrhage despite compression, bandages, and tourniquets. Several topical haemostatic agent were developed to try to face these situations. Their application was mainly described and studied in military environment. We report the case of a worker victim of an accident of construction site with hemorrhagic périnéal trauma for whom the use of a haemostatic bandage QuikClot ACS+TM (Z-Medica) seemed to us particularly useful in prehospital setting.
The Pectoralis Major tendon tears are rare pathologies but not exceptional and probably under diagnosed. Clinically, severe lesions of the Pectoralis Major’s tendon can cause conformational changes of the fossa axillaris whose for understanding requires a perfect knowledge of the tendon’s anatomy. Through our three cases experience, we present in this article the detailed methods of the inspection of the Pectoralis Major and explain the sometimes-surprising modifications of the fossa axillaris’ anterior wall conformation. While traditionally, only total or subtotal tears are considered as surgical, it appears more pertinent to describe total rupture, major partial tears and minor partial tears. As in the majority of tendinous ruptures, the diagnosis is mainly clinical and based primarily on the inspection of the fossa axillaris. A well- conducted inspection, while respecting a delayed time after the event, could help to classify the tears in these three categories without multiplying investigations. This attitude could have significant impacts and facilitate the following management