Resuscitation drugs: “We fear a shortage of stocks”

Damien Roux, university professor and hospital practitioner of intensive resuscitation medicine, works in the medical and surgical resuscitation department of Louis-Mourier Hospital (AP-HP), located in Colombes, in the Hauts-de-Seine. As of last weekend, this doctor was responsible for reflecting – in collaboration with other colleagues from the Public Assistance taking care of Covid-19 patients – on the means of optimizing the use of drugs in the services of resuscitation, due to the ever increasing number of serious patients. “The aim was to anticipate the overconsumption of certain drugs in the same way that we have been trying to increase the number of nurses for the past month»He explains. Except that a week later, the fear of an imminent shortage of certain molecules became a reality in Ile-de-France. “Despite our prospects and our vigilance on the issue, it is clear that suppliers and manufacturers are no longer able to monitor the consumption of drugs or certain medical devices in our hospitals.He warns.

AP-HP Director General Martin Hirsch acknowledged at a press conference on Friday that “stocks are very short on certain drugs.“This Saturday evening, it’s Edouard Philippe who admits the existence of”supply tensions here and there” “We regulate them by ensuring the circulation of these products throughout the territory, because there are stocks. We guarantee it by making sure to encourage increased domestic and global productionAdded the Prime Minister. Update with Professor Roux.

What is the situation of Louis-Mourier resuscitation service today?

We fear the beginning of a stock shortage for the end of the weekend. We have visibility over two days. That is to say, we are not sure that our internal pharmacy will be able to supply us with all of the drugs necessary for optimal patient management. There is great concern because it is very likely that the AP-HP central pharmacy, despite all its efforts, may not be able to meet the demands of all hospitals and that we will end up with shortages during the restocking. This shortage situation is new but ultimately quite logical. Instead of having a variety of patients who require very different treatments, resuscitation services are currently finding themselves with a majority of Covid + patients who need the same molecules. It is this quantity of identical patients, hitherto unknown in our units, which causes the drug shortage.

Which families of molecules are likely to be lacking?

There is a strong tension on hypnotics. These are the molecules we use to keep patients in sleep in intensive care. The equation is therefore simple: if we run out of stocks, we will no longer be able to take care of new patients. It’s a real danger. We also fear a rapid shortage of curares, which allow the patient, once asleep, to prevent him from moving and therefore consume less oxygen. Curares are necessary because they allow these patients with acute respiratory distress syndrome (ARDS) to be completely ventilated by the ventilator. The last other concern concerns antibiotics. As we speak, I do not believe that an AP-HP hospital is lacking. But there is a risk of overconsumption in the days and weeks to come, because these serious patients in intensive care are at high risk of nosocomial infection. As you can see, the supply of these three groups of molecules is essential to save lives.

Your working group’s mission was to think of new protocols to save your stocks. A summary of your recommendations is currently being sent to all AP-HP hospitals. What does it contain?

At this stage, we propose an optimization of the sedation protocols in order to limit any use which is not absolutely necessary. A close relationship between the pharmacy and the resuscitation service is also necessary in order to anticipate any shortage of a molecule to refer to another close molecule. We also underlined the interest of associating other molecules making it possible to reduce the quantity of usual molecules to be administered. More specifically for sedation, one of the recommendations would also be to use the usual method of anesthesia in the operating room. It is a procedure that uses halogenated gases to put people to sleep and that we never use in most resuscitation services. This technique would also limit the use of curares.

At Louis-Mourier Hospital, where are you with your stock of syringe pumps, which allow the infusion of treatments? Some hospital structures already seem to be lacking…

We did the drawer bottoms and requisitioned all the units a little to find as many as possible. But indeed, faced with the impressive influx of resuscitation patients, we had to resolve to work with fewer electric syringe pumps per patient. For the moment, it does not degrade the quality of care but it causes discomfort in work for nurses who must regularly move this type of equipment from one room to another. Unless suppliers, especially Chinese, can quickly send us a large quantity of electric syringe pumps, we will have to modify the way we administer treatments to patients using less precise techniques.


Anaïs Moran

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Coronavirus: in New Rochelle, “we try not to panic too much” – Release

Coronavirus: in New Rochelle, “we try not to panic too much” Liberation.

“The scandal”, obscure object of delirium

“Ithere is always something to see, provided you know how to look “, throws Paul Wagner (Maurice Ronet), during a bourgeois reception, to a friend who was annoyed by his rascal escapade escapades. Occurring in the first third of Scandal (1967), a false crime fiction and a true philosophical treatise on madness, almost anecdotal aside seems to give the viewer the keys to the film. It’s as much a sentence of a film buff as of an entomologist, a great architect of the world, having the gift of double vision or the sense of observation, to detect what is hidden behind appearances. But above all, she says that the world is not one, there is always another story, a logic that escapes logic, and that everything is a matter of look, interpretation, and therefore delirium. This is the occult subject that this thirteenth feature hides under its twisted whimsical air, whose codes Chabrol does not really respect – crimes but no investigation, no end of story, since nothing is unequivocal . It’s almost like it’s all in the head and sick brain of a character with shaky reason. The intrigue plays on this ambiguity: following a head trauma during an attack, where a prostitute was strangled before his eyes before he lost consciousness, Paul Wagner (Ronet, masterful as a childish and disturbed hero) is sometimes subject to absences. When other women around him are murdered, everything suggests that he may be the murderer, unless he is the victim of a plot, which we imagine to have been hatched by his cousin Christine (Yvonne Furneaux), wealthy champagne merchant, married to Christopher (Anthony Perkins), a former gigolo, who wishes to sell the domain of which Paul is still the owner of the name and exerts pressure and blackmail on him. But the presence of a blonde vamp (Stéphane Audran, beauty of elusive sphynx), haunting the place, leaves other mysteries hovering …

We are far from the original idea of ​​producer Raymond Eger – a murder in a nudist camp. To the “sans-pagne”, Chabrol and his accomplice from the start, Paul Gégauff, never stingy with Lacanian puns, will have preferred “champagne”. A rotten wine, like the big bourgeoisie that the filmmaker brushes with vitriol in their decadent evenings. Gégauff’s cynical pen infuses the film with an atmosphere of destructive madness that echoes the formal biases of the staging. From the credits in the colorful colors, Chabrol accredits the idea of ​​a mental film by multiplying the plans stretched to abstraction, the fluid circular movements, the slowness, the pattern of the spiral – wink at Vertigo by Hitchcock, who also evokes the role of the double brunette / blonde woman and the presence of Anthony Perkins.

Chabrol will often say that he was influenced by the thought of the philosopher Alfred Korzybski, general semantics and non-Aristotelian logic, namely the idea that a subject is always trapped in his representations. Starting from an undecidable point – is it Paul who is mad or the world around him, or both? -, the film constantly seems to adjust to the flickering perception of the hero, often under the influence of alcohol, and this distortion of reality is visually translated by formal audacity, games of mirrors and transparencies, dense decor of heterogeneous statues and objects, and up to the creeping gestures of Ronet. An astonishing final plan, taking height, will replace the scenario writer in the position of the demiurge entomologist, observing his characters, tangled bodies, to (d) fight like three worms in a box.


Nathalie Dray

The scandal of Claude Chabrol (1967), Blu-ray € 19.99 (BQHL).

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Pole vault: Duplantis, so young and already so high

[Mise à jour : Duplantis a franchi les 6,18 m le samedi 15 février à Glasgow]

Renaud Lavillenie is no longer a record holder in the world of pole vault. The French athletics star, who had the best world performance of all time since February 2014, when he jumped 6.16 m in Donetsk under the eyes of former record holder Sergei Bubka, passes his hand to the star rising specialty: Armand Duplantis, 20 years old. The latter, although born and raised in the United States (in Lafayette, Louisiana), competes under the colors of Sweden, his mother’s country. Duplantis, nicknamed “Mondo” in the narrow circle of athletics, passed the 6.18m mark in Glasgow on Saturday. He had already crossed the 6.17 m barrier at the indoor meeting in Torun, Poland, a week earlier. The performance of the young man with “normal” physique – 68 kilos for 1.81 m – is not really a surprise. Tuesday, in a meeting in Germany, he attacked the Lavillenie record and failed by nothing.

In the garden of the house

Armand Duplantis presents the typical CV of the prodigy of his discipline, to which he was initiated by his father and coach since his earliest childhood. He indeed started to panic the counters of the specialty at 10 years old. The son of Greg Duplantis and Helena Hedlund, a former volleyball player and heptathlete, and now her fitness trainer, began his jumping career in the garden of the family home. At 10, he crossed 3.86m, the world record for this age category. Passionate about the specialty are beginning to scrutinize the gestures of the child acrobat on YouTube. The father himself is a former American pole vaulter, capable of jumping 5.80m from the top of his 1.68m. It is perhaps thanks to the size of his father that the son drew his greatest strength: technique. When you don’t have a Superman physique, you have to bet everything on it, essential on the acrobatic part and speed. Qualities probably worked to nausea by Greg Duplantis and his son.

Duplantis displays perfect mastery of the different parts of which a pole vault consists. For the average viewer, this very complex exercise may seem easy and almost natural: but it is the mark of the virtuoso to give this impression. From this point of view, Duplantis has a lot in common with Renaud Lavillenie, his young idol, with whom he shared a few jumping sessions and long discussions about their sport.

Provider, athlete, tightrope walker

Just watch his jumps, for example at the European Championships in Berlin in August 2018, where at just 18 years old (still a junior then), he won one of the most distinguished contests in the history of this championship. At an Olympic stadium in Berlin, during an interminable summer evening, Duplantis had to pull from his hat of conjurer-athlete-tightrope walker a jump to 6.05 m, while the final seemed to end at 5.95 m. This measurement represented at the time his personal best and also the junior world record. Second place was for the young Russian Timur Morgunov (6.00 m), meteor of the discipline, while the bronze medal went to an always combative Renaud Lavillenie at the beautiful altitude of 5.95 m, which in most old editions would have given right to the highest step of the podium.

At the world championships in Doha, at the beginning of October 2019, Duplantis wins “only” the money behind another ace in the discipline, the American Sam Kendricks, in a competition not frankly high-flying: 5.97 m for Kendricks and Duplantis , the American winning the number of tries at 5.92 m. In Qatar, the Swede had appeared a bit sprained, perhaps because of the string of meetings which had made up his season. Saturday in Torun, on the second attempt at 6.17 m, Duplantis agreed with all of their opponents: he is now the boss of the discipline.

Luca Endrizzi

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