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TROUVAILLES ET ASTUCES


Index général

V. THERAPEUTIQUE - TREATMENTS
  1. a Solution de réhydratation orale en cas de diarrhée (solution de l'OMS) - Oral rehydration salts composition
    b
    Administrer une solution réhydratante à un petit enfant - Easy infant rehydration
  2. Comment donner un médicament à un nourrisson? - Medicating Infants
  3. Comment diviser facilement un comprimé? - Breaking Pills For Odd Doses
  4. Améliorer l'adhérence des patches - Making Patches Stick
  5. Traitement de la nausée - Popcorn for Nausea
  6. La brouette pour drainage postural - Play Wheelbarrow
  7. Insuffisance cardiaque - Hands-On Approach To CHF
  8. Traitement du hoquet - Hiccups treatment
  9. Aide à la réduction des fractures - Benzoin for Slippery Fingers
  10. Reste avec nous! - Treating Impending Unconsciousness
  11. La sciatique du porte-monnaie - Preventing Sciatica
  12. Aponévrosite plantaire - Alleviating Plantar Fasciitis Pain
  13. Manoeuvre pour la cupulolithiase - How to cure cupulolithiasis
  14. La canneberge contre les infections urinaires - Cranberry juice prevents urinary tract infection
  15. Protection rénale contre les produits de contraste - Acetylcysteine protects kidneys against iodine contrast media


5.1

a. Composition d'une solution de réhydratation orale en cas de diarrhée - Oral rehydration salts composition

Additionner à de l'eau bouillie ou épurée pour 1 litre au total - Add to boiled or purified water for 1 liter solution:

  • Solution de l'OMS - WHO rehydration solution (lower osmolarity 245 mOsm/l):
2,6 g Sodium chloride NaCl (sel de cuisine)
2,9 g Sodium citrate
1,5 g Potassium chloride (KCl)
13,5 g Glucose (sucre de raisin) [glucose may be replaced by 27 g saccharose (sucre ordinaire) ou/or 34 g de poudre de riz cuite (cooked rice powder)]
  • Recette plus simple: 8 cuill. à café de sucre [8 teaspoons sugar] + 1 cuill. à café de sel de cuisine [1 teaspoon salt] + jus de 2 oranges pressées [juice from 2 squeezed oranges] (Dr F-X Troillet, Rev.Med. S.Rom. 122:9, 2002)
  • Gerostar+: 7 cuill. à café de sucre + 1 cuill. à café de sel de cuisine + jus de 1 orange + 1 citron pressés (Pr. C-H. Rapin, Tribune Médicale:35, 27.8.2004)

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b. Administrer une solution réhydratante à un petit enfant - Easy infant rehydration

Lorsque les enfants refusent de boire une solution de réhydratation, on peut confectionner des bâtonnets glacés à l'aide d'une solution isotonique (p.ex. Isostar®). Cette "glace", très appréciée des enfants, permet de leur faire absorber environ 40 ml de soluté riche en électrolytes. De plus, le froid fait que cet apport risque moins d'être rejeté par les vomissements.

Dr Christophe Trachsel, Tribune Médicale No 38 21.9.2001

5.2 Comment donner un médicament à un nourrisson? - Medicating Infants

Administering oral medications to infants can be difficult. One way to make the process easier and less stressful for the baby is to offer the child an open-ended nipple into which you have inserted a 10-cc oral (ie, needleless) syringe containing the appropriate medication. As the young patient sucks on the nipple, the natural vacuum created will cause the syringe plunger to depress, expressing the medication into the infant's mouth. To facilitate the process, you can slowly depress the plunger as the infant sucks on the nipple.

Suzanne Sanders, CPNP, Salt Lake City, UT

5.3 Comment diviser facilement un comprimé? - Breaking Pills For Odd Doses

To avoid the frustration and inefficiency of inferior methods when dividing pills for fractional doses, take a round toothpick and lay it on a counter. Place the pill on top (with the score on the pill parallel to the toothpick) and press down. The pill splits evenly and can be conveniently caught between thumb and counter. This simple procedure is effective for any size tablet.

John R. Fullick, PA-C, Pine Mountain, GA top

5.4 Améliorer l'adhérence des patches - Making Patches Stick

When patients complain that transdermal patches do not stick, try applying magnesia and alumina oral-suspension antacid to the problem area. Allow it to dry, then brush off. The patch will then stay in place.

Lisa Allen, PA, Muleshoe, TX

5.5 Traitement de la nausée - Popcorn for Nausea

Day-old, unsalted popcorn is an inexpensive way to combat nausea caused by such conditions as pregnancy or motion sickness. Ideally, the patient should eat the popcorn 1 hour before or 2 hours after ingesting fluids.

Nancy Bowens, RN, WHCNP, APNP, Two Rivers, Wis

5.6 La brouette pour drainage postural - Play Wheelbarrow

To perform postural drainage on a young patient with bronchitis or pneumonia, hold the child's legs like wheelbarrow handles while the child walks on his or her arms. The patient will cough and gravity will take care of the rest.

Deb Pope, CPNP, Accomac, Va top

5.7 Insuffisance cardiaque - Hands-On Approach To CHF

Use the following steps to teach patients with congestive heart failure (CHF) how to manage their restricted fluid and salt intake:

1) Fluids: Give your patient a graduated container marked at the maximum fluid level per 24 hours. Then give your patient two 5-ounce cups, explaining that one cup is for fluid consumption, and the other is to measure an equal amount of water to be poured into the graduated container to track daily fluid intake.

2) Salt: Tell your patient not to cook with salt, but only use it at the table. Then instruct your patient to use a single salt shaker filled with the daily maximum of salt each day. That way, when the salt is gone, the patient realizes that the daily allotment has been consumed.

Lyn A. Govette, PA-C, Flint, Mich

5.8 Traitement du hoquet - Hiccups treatment

Three days after the onset of hiccups, the hiccups can be considered intractable and controlled almost 100% with the administration of low dose oral thorazine. By the time of intractability, most patients have tried numerous home remedies. Medical pathology should be considered and ruled out. IV reglan also has had some positive effect but the oral route has no effect.

Lawrence Ellison, MSW, PHD, Brookings, Oregon, Medscape, 3.9.99

5.8.1 By sucking on a sugar cube or swallowing a packet of sugar, one can quickly and easily end a bout of hiccups, while adding a bit of sweetness to the palate.

Jesse V. Green, NREMT-B, Pre-Med student

5.8.2 Put one teaspoon of fresh lemon juice on the tongue.

Dr. Uzi Oppenheimer, Israel top

5.9 Aide à la réduction des fractures - Benzoin for Slippery Fingers

To prevent slippery fingers when performing a closed reduction for a finger/toe dislocation, apply tincture of benzoin to both the patient's dislocated phalanx and to your hand.

Kim Ownby, PA, Markesan, Wis

5.10 Reste avec nous! - Treating Impending Unconsciousness

Press firmly with a pointed dull instrument (a pen works nicely) on the area between nose and upper lip.

Dr. Uzi Oppenheimer

5.11 La sciatique du porte-monnaie - Preventing Sciatica

For some patients, the answer to prevention of sciatica may be found right in their pockets. Carrying a wallet in the back pants pocket may cause excess pressure on the sciatic nerve, especially in those who spend much of their time seated.

Robin Love, FNP, Cheshire, Mass top

5.12 Aponévrosite plantaire - Alleviating Plantar Fasciitis Pain

Patients with severe pain from plantar fasciitis should wear a stirrup ankle splint during the day. Together with nonsteroidal anti-inflammatory drugs and stretching exercises, splints provide good pain control by preventing plantar flexion of the involved foot during ambulation. For protracted pain, have patients wear a posterior splint during the night.

Mary Beth Trachtenberg, RN, CS, FNP, Portage, IN

5.13 Manoeuvre pour la cupulolithiase - How to cure cupulolithiasis

Manoeuvre libératoire selon le Pr Brandt: en position assise, la tête est tournée de 45 degrés vers l'oreille non atteinte (côté sain). Les otolithes se trouvent à la base du canal semi-circulaire postérieur. Coucher le patient du côté de l'oreille atteinte en maintenant la position de la tête. Les otolithes se déplacent du fait de la gravité, ce qui déclenche un nystagmus rotatoire vers l'oreille la plus basse. Maintenir la position pendant deux minutes. Tout en maintenant la tête dans la même position, basculer rapidement le corps de 180 degrés du côté opposé, le nez dirigé vers le bas. Les otolithes se déplacent maintenant vers la sortie du canal semi-circulaire postérieur. Maintenir la position pendant deux minutes. Lorsque le patient se relève, les otolithes ont gagné l'utricule où ils ne déclenchent plus de vertige rotatoire.

Tribune Médicale, No 20, 19.5.2000 top

5.14 La canneberge contre les infections urinaires - Cranberry juice prevents urinary tract infection

50 ml of cranberry-lingonberry juice concentrate daily reduces recurrences of symptomatic urinary tract infection by about half compared with a control group.
La prise quotidienne de 50 ml de jus concentré de canneberge (Vaccinum macrocarpum Aiton, airelle des marais) permet de réduire de 50% la fréquence des infections urinaires récidivantes.

BMJ 2001; 322: 1571-3

5.15 Protection rénale contre les produits de contraste - Acetylcysteine protects kidneys against iodine contrast media

Prophylactic oral administration of the antioxidant acetylcysteine (2x600mg the day before and the day after examination), along with hydration, prevents the reduction in renal function induced by a nonionic, low-osmolality contrast agent, in patients with chronic renal insufficiency.
L'administration d'acétylcystéine avant et après l'exposition à un produit de contraste, en association avec une hydratation adéquate, prévient l'aggravation d'une insuffisance rénale préexistante.

N Engl J Med 2000;343:180-4

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