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Patients in emergency situations or life distress most often need a intravenous line (IV) to give them the medications they need. The IV route is the preferred route to treat most of the patients in emergency situations out of hospital or in the emergency room but can be very tricky to obtain. Various alternatives have been developed, such as the intraosseous route, particularly useful in cases of venous collapse (shock, cardiorespiratory arrest), the intramuscular route (anaphylaxis, sedation) or the intranasal route (status epilepticus, analgesia). This article reviews the indications, contraindications and pharmacology of these different routes., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article

A 50-year-old individual identified as a 'frequent user' of emergency services due to chronic abdominal pain was transported to the emergency department by ambulance during a new episode of abdominal pain. Despite being initially deemed stable by paramedics, the patient was not reassessed by the triage nurse upon arrival. Subsequently, the patient presented with severe pain, arterial hypotension, and tachycardia. Following a multidisciplinary protocol for pain management, analgesic treatment was initiated. Despite several hours of management and repeated assessments, an abdominal CT-scan was eventually conducted, revealing a perforated small intestine. The application of the 'frequent user' label may have contributed to a delay in the provision of timely care for this patient.

Chronic hiccups, lasting more than 48 hours, are a medical condition that remains challenging in both diagnosis and treatment. They can be the sole symptom of a serious underlying disorder, and should therefore not be overlooked, although gastroesophageal reflux disease (GERD) constitutes their most prevalent cause. Chronic hiccups mandate a comprehensive etiological assessment. Treatment strategy may include physical, pharmacological and interventional approaches, as described in literature, particularly when direct causal treatment is unattainable., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Switzerland, after having been a nation of emigration for a long time, has seen its situation reversed with the industrial revolution and a succession of international crises responsible for several waves of migration. Some of these immigrants have health needs that vary according to their country of origin and their migratory route. Due to communication difficulties or legal issues, they do not always have access to appropriate health care. Although Switzerland tries to provide a framework and coordinate the care pathway, inequalities persist. Good information for professionals and patients, the use of trained interpreters and knowledge of local structures to which these patients can be referred might improve the situation., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

In recent years, artificial intelligence (AI) has become increasingly important in our healthcare systems and in patient care. Several programs are now able to detect and localize fractures on conventional X-rays. Studies show that coupled with human interpretation, these software programs improve diagnostic performance and reduce healthcare costs. However, they are not infallible (variable specificity and sensitivity according to studies). This article shows through a clinical case the challenges and analytical biases of AI in the diagnostic process.

Internal ventricular shunts are systems for draining excess cerebrospinal fluid to another body cavity in patients with hydrocephalus. They are subject to complications that are sometimes difficult to identify and can lead to diagnostic errors if practitioners are not enough aware. The most frequent complications are mechanical (drainage dysfunction) and infectious. Interruption of the drainage may causeneurological signs of intracranial hypertension; the diagnosis is usually easy. However, the clinical signs can sometimes be less obvious, and a dysfunction of the shunt should be evoked. A multidisciplinary management with the neurosurgery team is necessary to evaluate the appropriate investigation and the emergency management., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Intraosseous infusion provides a safe and effective access to the vascular system that allows for administration of urgent therapies in both adults and children. It has few contraindications and complications are rare. The needle is most commonly inserted in the proximal tibia or anterior humerus. Different devices are available but those with a traditional drill are the most widespread. The intraosseous infusion procedure is easy and the learning curve is short, making it the best alternative when traditional intravenous access is not possible or delayed., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Status epilepticus is a feared complication in patients with epilepsy with a mortality rate of almost 10%. It is important to recognize this clinical entity quickly. A delay in diagnosis or treatment has significant consequences on mortality and morbidity. This article is a review of the current literature and aims to provide management of status epilepticus in the emergency department by adults., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The Swiss rescue system is based on a collaboration of two trades (ambulance and emergency physician). Paramedic provide independent support for most urgent medical situations under the cover of three years of training and a medical delegation. For more complex situations, the prehospital physician retains his place (triage, severe trauma, airway management, respiratory distress, medico-legal emergencies, specialized procedures or exceptional situations). This collaboration is the foundation of the Swiss prehospital system. One does not go without the other., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation

While some sexual traumas are anecdotal, others are more serious and require specific and urgent medical care. This article reviews the main problems that can arise during sexual acts and reminds the importance of detecting and treating sexually transmitted diseases., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Importance of bedside ultrasonography (BU) is growing in the emergency medicine. Many reasons support the use of the focused ultrasounds in the emergencies services such as : helping in diagnosis, improving invasive gestures and other treatments strategies. The implementation of a focused ultrasonography has a low financial impact but a high educational value. In despite of the existent education and training programs, the focused ultrasonography only has a low diffusion/practice in the emergency departments in Suisse romande. Here we describe the implementation on a focused ultrasonography program for our institution (HFR : Hôpital fribourgeois)., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Headaches in a pregnant woman imply a specific management for this population. However this article aims to show that the adaptations both from a diagnostic and therapeutic standpoint are modest compared to the classical management of the headache in the emergency department. Indeed, few etiologies are specific to headaches in pregnancy, however they have to be known and excluded. The same applies to treatment, which also needs some small but crucial adjustments, given the possible consequences on the mother and fetus., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.