[Actions of the French Military Medical Service in the war against COVID-19: ].

"" declared President Emmanuel Macron during a speech to the nation on March 16, 2020. As part of this national resilience, the French Military Medical Service was engaged in the fight against COVID-19. This general review aims to describe and detail the actions undertaken by the French Military Medical Service in the national fight against the COVID-19 pandemic in France, as well as abroad.

Outcomes of COVID-19-Related ARDS Patients Hospitalized in a Military Field Intensive Care Unit.

Introduction: Little evidence of outcome is available on critically ill Coronavirus Disease 2019 (COVID-19) patients hospitalized in a field hospital. Our purpose was to report outcomes of critically ill COVID-19 patients after hospitalization in a field intensive care unit (ICU), established under military tents in a civil-military collaboration.

Methods: All patients with COVID-19-related acute respiratory distress syndrome (ARDS) admitted to the Military Health Service Field Intensive Care Unit in Mulhouse (France) between March 24, 2020, and May 7, 2020, were included in the study.

A beat-by-beat cardiovascular index, CARDEAN, to titrate opioid administration in the setting of orthopaedic surgery: a prospective randomized trial.

To determine whether a beat-by-beat cardiovascular index (CARDEAN: cardiovascular depth of analgesia, Alpha-2 Ltd, Lyon, France) reduces the incidence of tachycardia in ASA I-III patients undergoing orthopaedic surgery. A total of 76 patients were prospectively randomized into (1) a control group or (2) the CARDEAN group, in which the nurse anaesthetist was blinded to CARDEAN application. In addition to conventional signs, an external observer instructed the nurse anaesthetist to administer sufentanil 0.

How do we fight COVID-19? Military medical actions in the war against the COVID-19 pandemic in France.

'', French President Emmanuel Macron said in an address to the nation on 16 March 2020. As part of this national effort, the French Military Medical Service (FMMS) is committed to the fight against COVID-19. This original report aimed to describe and detail actions that the FMMS has carried out in the nationwide fight against the COVID-19 pandemic in France, as well as overseas.

Tactical damage control resuscitation in austere military environments.

Background: Despite the early uses of tourniquets and haemostatic dressings, blood loss still accounts for the vast majority of preventable deaths on the battlefield. Over the last few years, progress has been made in the management of such injuries, especially with the use of damage control resuscitation concepts. The early application of these procedures, on the field, may constitute the best opportunity to improve survival from combat injury during remote operations.

Predeployment training for forward medicalisation in a combat zone: the specific policy of the French Military Health Service.

Introduction: To improve the mortality rate on the battlefield, and especially the potentially survivable pre-Medical Treatment Facility deaths, Tactical Combat Casualty Care (TCCC) is now considered as a reference for management of combat casualty from the point of injury to the first medical treatment facility. TCCC comprises of a set of trauma management guidelines designed for use on the battlefield. The French Military Health Service also standardised a dedicated training programme, entitled "Sauvetage au Combat" (SC) ("forward combat casualty care"), with the characteristic of forward medicalisation on the battlefield, the medical team being projected as close as possible to the casualty at the point of injury.

[Contribution of information technologies to assess and improve professional practice: example of management of surgical antibiotic prophylaxis].

Introduction: Information technologies appear to be interesting tools to assess and improve professional practices. In that setting, the management of surgical antibiotic prophylaxis represents an appropriate clinical area for using and evaluating such a tool. Despite the existence of guidelines in one hand and the demonstrated interest for a strict application of recommendations in the other hand, some irregularities in the management of surgical antibiotic prophylaxis remain in France in 2010.

[Cricothyrotomy for airways management: current data and interest for combat casualty care].

Objectives: To detail current data in cricothyrotomy and imperatives of airway management in combat casualty care.

Methods: Review of the literature in Medline database over the past 40 years.

Results: Modern armed conflicts, including guerrilla and terrorism, have changed the approach of tactical combat casualty care.

A beat-by-beat cardiovascular index, CARDEAN: a prospective randomized assessment of its utility for the reduction of movement during colonoscopy.

Background: We sought to determine whether online use of a beat-by-beat cardiovascular index, CARDEAN (Alpha-2, Lyon, France), modifies the incidence of patient movement during colonoscopy under anesthesia.

Methods: Monitoring included an electrocardiogram, oscillometric and noninvasive beat-by-beat arterial blood pressure, O2 saturation, bispectral index (BIS), and CARDEAN. CARDEAN consists of beat-by-beat Finapres (Ohmeda, Madison, WI) combined with an algorithm that detects hypertension followed by tachycardia and produces an index scaled 0 to 100.

[Acute renal failure related to urinary retention following haemorrhoidectomy performed under general anaesthesia and bilateral pudendal nerve block: a case report].

Anorectal surgery is associated with significant postoperative pain. Pudendal nerve blocks, formerly performed by surgeons, provides effective postoperative analgesia and allow a quicker recovery, which is quite important in the current concept of fast-track postoperative care. However, even for benign surgery with a safe anaesthetic technique, serious adverse events may occur.

Laryngeal dyspnea in relation to an interaction between acenocoumarol and topical econazole lotion.

Background: Bleeding is the most serious complication of oral anticoagulant therapy used for the prevention of thromboembolic complications. Drug-drug interactions are an important concern, as they may increase drug toxicity and, in the case of anticoagulant therapies, increase the risk of hemorrhage.

Case Summary: An 84-year-old woman presented to the emergency department with a bilateral cervical hematoma and symptoms of upper-airway obstruction that had been increasing for 72 hours, with dyspnea and difficulty speaking developing in the previous 24 hours.

Beat-by-beat cardiovascular index to predict unexpected intraoperative movement in anesthetized unparalyzed patients: a retrospective analysis.

Objective: Unexpected intraoperative movement may be detrimental during delicate surgery. This study tested retrospectively an algorithm based on beat-by-beat circulatory variables (incorporated into a Cardiovascular depth of anesthesia index: CARDEAN in relationship to unexpected movement, and compared its performance to that of the electroencephalogram (EEG)-derived index: BIS-XP 4.0.

Screening for multidrug-resistant bacteria as a predictive test for subsequent onset of nosocomial infection.

Objective: To investigate whether carriage of multidrug-resistant bacteria is a risk factor for nosocomial infection and whether detection of carriage is predictive of subsequent onset of nosocomial infection.

Methods: In this observational cohort (study period, June 1998 through October 2002), nasal and rectal swab specimens from 412 consecutive patients admitted to the intensive care unit were tested for carriage of multidrug-resistant bacteria. Concomitantly, the bacteria responsible for any subsequent nosocomial infection, the date of infection, and some of the known clinical risk factors for nosocomial infection were noted.

Immediate postoperative refeeding in orthopedic surgery is safe.

The purpose of this retrospective study was to investigate the morbidity of immediate postoperative refeeding after orthopedic surgery. We included all the 1077 patients who underwent orthopedic surgery between January and December 2003 at our military teaching hospital. General anesthesia was performed in 37% of the patients (n = 398), 24% (n = 259) had combined general and regional anesthesia, and 39% (n = 420) had isolated regional anesthesia (spinal anesthesia and/or peripheral regional anesthesia).

[Important hypercalcaemia due to hyperparathyroidism induced by lithium].

Lithium treatment, which is still extensively used in bipolar affective disorders, may give rise to hypercalcaemia induced by hyperparathyroidism. We present a patient of 50-year-old treated with lithium for 19 years for bipolar illness and who developed an important hypercalcaemia. After symptomatic treatment of the hypercalcaemia and extrarenal dialysis the clinical evolution was favorable but measurements of serum calcium and parathormon showed that he had developed hyperparathyroidism.

[Hypokalaemic paralysis disclosing hyperthyroidism].

Thyrotoxic hypokaliaemic paralysis is a rare cause of severe hypokalaemia. We report the case of a 34-year-old Asiatic man who presented in our emergency department an episode of quadriplegia due to low plasma potassium levels. Biological test discovered a Basedow disease, confirmed thyrotoxic paralysis.

[Convulsions due to a postpartum cerebral angiopathy associated with the administration of bromocriptine].

We report a case of postpartum convulsions due to a benign cerebral angiopathy occurring after bromocriptine therapy to suppress lactation. This case analyses the current knowledge concerning this rare entity. It allows pointing out special measures that must be taken with the administration of bromocriptine.

[Unusual complication after hip surgery under spinal anesthesia].

The development of an acute respiratory distress syndrome following hip surgery in elderly patients is suggestive of thromboembolism in most instances. However, we must keep in mind the possibility of rarer complications, which can remain undiagnosed because they are hidden by prominent abnormal behaviours, which can develop following any type of anaesthesia. We report the case of a patient who developed a confusion following an orthopaedic surgery under spinal anaesthesia; this confusion concealed a penetration syndrome resulting from accidental inhalation of a dental crown.

[Severe complications after a translaryngeal tracheotomy].

We report the case of a 71-year-old man receiving anticoagulant treatment because of a mechanical aortic valve. Because of an unsuccessful weaning after abdominal surgery, a translaryngeal tracheostomy was realised without incident. The patient died few days later after a hypoxic cardiac arrest due to a severe haemorrhage after the first recannulation.