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In medicina d’urgenza, il dolore acuto è una realtà che riguarda la maggior parte dei pazienti. È accertato che la sua gestione sia una situazione d’urgenza a causa dei suoi effetti potenzialmente nocivi. Questa gestione deve essere individualizzata, vale a dire adattata al dolore, al paziente e alla patologia causale. La valutazione del dolore e la misurazione della sua intensità sono fondamentali per una buona gestione, ma queste devono essere adattate ad ogni paziente. La gestione del dolore si basa sulla multimodalità, utilizzando mezzi farmacologici e non farmacologici e, soprattutto, una collaborazione e un atteggiamento empatico del caregiver. La morfina è un analgesico importante il cui uso potrebbe essere più esteso attraverso specifiche procedure e la corretta formazione dei caregiver. Inoltre, devono essere anticipati i dolori provocati da procedure e interventi. Alcune procedure richiedono una vera e propria sedazione, che deve essere perfettamente padroneggiata dalle equipe di operatori sanitari per limitare il rischio di effetti collaterali.

L’accroissement du nombre de personnes âgées (PA) s’accompagne d’une augmentation du nombre de consultations aux urgences. Les structures d’urgences (SU) doivent répondre à leurs besoins spécifiques. Les longs temps de passage en SU des PA de plus de 85 ans nous ont conduits à nous interroger sur la possibilité d’accélérer le passage à l’unité d’hospitalisation de courte durée (UHCD) de ces patients, par la création d’un algorithme appelé « fast-track personnes âgées » (FTPA). Le FTPA, consiste en l’admission des PA à l’UHCD dans les deux heures, afin de diminuer leur temps de passage en SU. L’objectif de ce travail est de montrer l’adhésion des médecins à un tel algorithme. Nous avons mené une étude monocentrique descriptive, durant un mois, sur l’adhésion des équipes à la mise en place de cet algorithme. Pour cela, nous avons comparé le nombre de patients inclus, hospitalisés en moins de 2h, aux mois de mars 2014 et 2015, au nombre de patients éligibles à l’inclusion dans cette algorithme décisionnel. Au-delà de 60 % de patients inclus, l’algorithme sera considéré comme applicable. Au mois de mars 2015, 334 patients de plus de 85 ans ont consulté, 133 patients auraient pu être inclus dans le FTPA et 100 l’ont été, soit 75 %, vs 30 % en mars 2014. L’utilisation d’un algorithme décisionnel d’aide à l’orientation des PA est applicable. The increasing number of elderly patients (EP) is related to an increasing number of emergency department (ED) visits. ED must meet their specific needs. The increasing length of stay (LOS) in the ED of persons over 85 years have led us to question the possibility of speeding up their transfer to the ED observation unit, by creating an algorithm called “fast-track for elderly patients”. this fast-track consists of the admission of the EP to the ED observation hospitalization unit within two hours, to reduce their LOS in ED. The objective of this work is to show the adherence of physicians to such an algorithm. We conducted a single-center descriptive survey, over a month, on the compliance of medical team to this algorithm. For this, we compared the number of patients included, hospitalized in less than 2 hours, in March 2014 and March 2015, to the number of patients eligible for inclusion in the algorithm. Beyond 60% of patients included, the algorithm will be considered practicable. In March 2015, 334 EP consulted, 133 could have been included and 100 were included (75%), vs 30 % in March 2014. Setting up a decision algorithm to help the guidance of EP is workable.

The potential role of socio-economic status (SES) in COVID-19 remains unknown. The highest excess mortality rate in France linked to COVID-19 is reported in the Seine-Saint-Denis (SSD) district, which is the poorest district of the Greater Paris Area. Our objective was to compare patient characteristics between two districts of Greater Paris and determine whether precarity is a risk factor for severe COVID-19 respiratory disease at hospital admission. We selected patients hospitalized for COVID-19 from three academic hospitals, one located in SSD, and two in the Hauts-de-Seine (HDS) district, a rich district of Greater Paris. All selected patients were prospectively screened on the same day (April 20, 2020). Patients were asked about their SES via a questionnaire and information on smoking habits, comorbidities, and respiratory severity at admission was collected.

Le rôle du statut socio-économique (SSE) dans l’infection au COVID-19 est mal inconnu. En France mars-avril 2020, le taux de surmortalité lié au COVID-19 le plus élevé a touché la Seine-Saint-Denis (SSD), le département le plus pauvre du Grand Paris.