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An acute severe flare of ulcerative colitis is observed in approximately one patient out of four with a global mortality rate of 1%. Goal of the management of this medico-surgical emergency is based on patient profile, aiming to save life of the most aged and fragile patients and to avoid salvage colectomy in the others. Medical management is standardized, based on short treatment courses starting with intravenous steroids followed by cyclosporine or infliximab in case of failure. Surgery should be discussed at each step. Postoperative morbi-mortality is closely related to the duration of the preoperative management. Drug positioning of new molecules such as védolizumab, ustekinumab and tofacitinib is not well established in acute severe ulcerative colitis. [ABSTRACT FROM AUTHOR]

Hereditary metabolic diseases (IMDs) are a group of more than 1 400 rares genetic diseases resulting from a genetic deficiency of an enzyme or transporter involved in metabolism. They most often begin in childhood. If left untreated, most of them result in significant morbidity and mortality. With advances in management, 90% of children survivent into adulthood. Within IMDs, the diet and energy metabolism disease groups require very specific dietary management and emergency management due to the risk of acute decompensation during fevers or other stresses. It is therefore essential that children and adolescents, accompanied by their families, follow an appropriate transition programme. In 2017, the G2m network published the first recommendations on transition, particularly for diet-dependent diseases. A transition booklet for young patients was developed based on this publication. Since 2019, the working group including several patient organisations has organised thematic days and meetings on transition and created a child-adult transition passport booklet. Lysosomal diseases have been the subject of recommendations based on a survey of patients, families and doctors with the aim of crea-aborting a specific transition programme called "TENALYS" (Transition ENfant Adulte dans les maladies LYSosomales). The members of the G2m network are involved in the d evelopment of other transition programmes: transition in Pompe disease as well as transversal transition programmes for rare diseases ("La Suite" at the Necker hospital and "JUMP" at the Pitié-Salpêtrière hospital). [ABSTRACT FROM AUTHOR]

Introduction: Oligoanalgesia is the inappropriate use of analgesics. It is a problem that is still prevalent in emergency departments. The main objective of this study was to conduct an inventory of pain management in the emergency department of the Al Mansour prefectural hospital in Casablanca and to determine the factors associated with oligoanalgesia. Material and methods: This is a cross-sectional study, carried out during the month of April 2019, through a heteroquestionnaire administered and completed by emergency room prescribers during this period. They informed their evaluation of pain via the numerical scale of patients who declared themselves to be in pain and completed their sociodemographic and clinical data as well as their management. Results: Of the 475 patients admitted to the emergency department, 64.2% presented with pain. The average age of these patients was 36 (± 17) years. Trauma was the most frequent cause of pain (55.7%). Eighty percent of the patients received analgesics. More than half of the patients (53.5%) were not relieved at discharge from the emergency department. The factors associated with this oligoanalgesia were: male gender (ORa = 1.98 [1.20-3.27]), the absence of pre-hospital analgesic medication (ORa = 3.31 [1.81-6.04]) and the absence of non-drug analgesia in the emergency room (ORa = 6.68 [2.45-15.22]). The abdominal-pelvic location of pain was a protective factor (ORa = 0.28 [0.08-0.93]). Conclusion: We confirm in this Moroccan study the public health problem represented by oligoanalgesia. [ABSTRACT FROM AUTHOR]

The Tōhoku Pacific Coast earthquake on 11 March 2011 severely disrupted transport networks, suddenly jeopardising a large part of Japan, and prompting authorities to take fast action. Refugees and inhabitants of the affected areas were forced to adapt their transport needs. This unprecedented situation laid bare the need for a more resilient Japanese transportation infrastructure in order to significantly improve physical and social reconstruction capacity during an emergency situation. This paper analyses the damage and impact of the disaster on transport and its energy infrastructure, reviews the measures adopted, and assesses past and acquired resilience. [ABSTRACT FROM AUTHOR]

Disaster myths pose a great challenge in disaster risk management all over the world. These misconceptions mean barriers to disaster higher education as well. This research is designed to examine these beliefs among disaster management students at the National University of Public Service, Hungary, as well as in a control group compiled from students from three other Hungarian universities. Based on the methodology of research published by David Alexander, a questionnaire was edited with 19 false statements about disaster events. Respondents had to evaluate them on a Likert scale from 1 to 5, where 1 means "completely disagree" and 5 means "completely agree". Strong agreement was expressed for some of the misconceptions regarding disasters (e.g. unburied bodies constitute a serious health hazard), and to a lesser degree for others (e.g. disasters cannot be managed systematically). The results of the control group reached similar values to those of the test groups, however in some cases the former tend to be more skeptical about the statements. Although Hungarian students shared the same beliefs as US and Italian students, the Hungarians seem to be less critical of the statements. These disaster myths create a serious problem in disaster higher education and have a great impact on future disaster managers in the field. [ABSTRACT FROM AUTHOR]

Objective To identify the determinants of the delay in the management of these emergencies and to evaluate its impact on the prognosis of the patients. Method Descriptive prospective study from November 15, 2018 to July 15, 2019 at Bethesda Hospital in Cotonou, Benin. Result The prevalence of non-traumatic abdominal surgical emergencies was 76.32%. These emergencies were dominated by acute appendicitis (61.84%) and acute peritonitis (27.63%). The mean age of the patients was 28 ± 15.43 years. The sex ratio was 0.77. Patients had a monthly income of? 100,000 FCFA (68.42%) and did not have health insurance (93.42%). The average time for surgical consultation was 6 days. In 76.32% of cases patients had consulted beyond the 72nd hour after the onset of signs. Before consulting in surgery, 89.43% of patients took a medication. The average time for surgical management was 10 hours. The delay of care was mainly related to the limited financial means of the patients, but also to the dysfunction of the host health facility. The postoperative morbidity was 22.37% and concerned more patients who consulted beyond the 72nd hour. The mortality was 5.26% and concerned the group of patients who consulted after the 72nd hour. The mean duration of hospitalization was 6.8 ± 4.04 days. The reasons for this delay in consultation were diagnostic wanderings (36.84%), the first use of self-medication (36.84%) and treatment with indigene (32.89%). The delay of care was mainly related to the limited financial means of the patients, but also to the dysfunction of the host health facility. Conclusion The prevalence of delayed management of non-traumatic abdominal surgical emergencies was high. Appropriate public health actions are needed to improve the quality of care. [ABSTRACT FROM AUTHOR]

The article informs that bankruptcies and social plans expected in many sectors with correctness and courage of political choices and economic factors of the disaster. Topics include incredible concerns misuse of the drug and its consequences; and the domain of health, remember that the emergency plan for the public hospital of the hospital debt.

Burns to the upper limb caused by contact with a hot press are associated with a compression trauma of variable severity. These burns are rare, and they mostly occur in the context of accidents at work due to mishandling. They can cause severe multi-tissue injuries requiring urgent multidisciplinary care. Their psycho-social repercussions are considerable, especially as they affect a young population. [ABSTRACT FROM AUTHOR]

On 6 July 2013, in Lac Mégantic, Quebec, the explosion of an MMA train, carrying light petroleum hydrocarbons, annihilated the downtown area of this 6000-inhabitant community. A total of 47 people lost their lives in this tragic accident and 5978 m3 of petroleum sub-products spilled into Lake Mégantic and the Chaudière River, not counting the incomplete combustion products that were dispersed with the smoke form the fire. This was the worst petroleum spill on land in Canada. The accident and the management of the environmental catastrophe revealed major deficiencies at several levels: transport safety of hazardous materials, preparedness of municipalities facing environmental emergencies, relevance and adequacy of emergency measures, environmental risk assessment, assessment of contamination and selection and speed of rehabilitation measures. This article describes the accident, the emergency measures applied and the environmental impacts of petroleum contaminants. It states and analyses the characterization data on water, soils, sediment and air supplied by the government, environmental organisations and universities. It addresses sanitary issues and solutions, such as potable water supply for some communities along the Chaudière River, surface water, groundwater, sediments and soil contamination issues, as well as the future of contaminants and their potential long-term cumulative impacts. This article proposes recommendations for signaling the deficiencies and critical needs as pertains to regulations, infrastructure, training and knowledge so the populations and municipal services may be better prepared to face future similar situations and events. [Journal translation] [ABSTRACT FROM AUTHOR]

Abstract: Objectives: One objective is to state more accurately the difficulties met by the anaesthesiologists in an emergency context in case of withholding or withdrawing life sustaining therapies. Study design and participants: A questionnaire addressed to anaesthesiologists of nine hospitals in the extreme West part of France. Materials and methods: The questionnaires were sent and returned by mail in order to guarantee confidentiality. Results: The participation rate was 40% with 172 questionnaires analysed. Ninety-eight per cent of the anaesthesiologists have already participated in a withholding or withdrawing life sustaining treatments, and in an emergency context in 92% of the cases. In that last case, criteria related to the severity of the clinic presentation and to the short-term death probability influence the decision made to interrupt life-sustaining therapies. For 93% of anaesthesiologists, the decision should be collegial, but 50% of them had already made such a decision alone. The withdrawal of ventilatory support was the most difficult decision to make. Withdrawing mechanical ventilation or extubating appeared impossible for 23.4 and 50% of the anaesthesiologists respectively. Providing comfort care to the patients with end of life decision was essential for 100% of the anaesthesiologists, but 11% of them used and considered analgesic and sedation after withholding or withdrawing life sustaining treatments as euthanasia. The complaint possibility worried 57% of the anaesthesiologists and influenced the writing of the process or giving information to the families respectively for 65 and 75%. The righting of the medical files could be improved for 92% of the anaesthesiologists. Conclusion: The decision of withholding and withdrawing life sustaining treatments in an emergency context is based on the conviction of short-term death probability. Withholding and withdrawing life sustaining treatments is a decision made according to the principles of collegiality and necessary comfort cares, but the procedure can still be improved, especially in the redaction of the medical file and the ethical and juridical control of these extreme situations. [Copyright &y& Elsevier]

Abstract: Objective: Several studies have highlighted the assets of the influenza rapid diagnostic tests (IRDT) for the emergency department management of febrile children. The objective of this study was to determine in ambulatory pediatric setting impact of IRDT on the management of febrile children during an epidemic, especially on other diagnostic testing performed, antibiotic and antiviral treatments. Methods: During an influenza epidemic, 37 paediatricians in three different areas of France included all children presenting fever with respiratory illnesses; they performed IRDT (test QuickVue® for Influenza A and B, Quidel). Data collected were antiflu vaccination, previous asthma, symptoms, clinical signs, other diagnostic testing performed, and a follow-up two weeks later. Results: Between December, 2006 and April, 2007, 695 children entered the program. The average age of those children was 4.1 years old (SD 3.4), median 3.2 (0.07–17.5). In 41.6% of the cases, the tests proved positive. Among 13 symptoms of influenza, only five were significantly more present in the group IRDT+: shiver (68.1% versus 57.4%), asthenia (87% versus 79.9%), cough (87.5% versus 70.1%), rhinorrhea (93.4% versus 83.3%), and sleepiness (54.2% versus 43.4%). The number of laboratory tests and radiographs ordered were less frequent in group IRDT+ than in group IRDT-: respectively 0.7% versus 11.6%, and 0.7% versus 8.6% (p <0.0001). IRDT+ group received antibiotics in 7.6% of cases (22 patients, 20 for OMA) and antiviral in 64.7%. IRDT- group received respectively 18.5% antibiotics, and no antiviral (p <0.0001). Conclusion: This study confirms the difficulty of clinical influenza diagnosis, and suggests the assets of IRDT to diagnose influenza and to improve the management of influenza in ambulatory paediatric setting. [Copyright &y& Elsevier]

Abstract: Objective: The objective was to test the application of barrier precautions and hospital organization during an influenza pandemic, in accordance with the national program of influenza pandemic training and the “Influenza addendum” of the hospital guidelines in case of a major disaster. Method: A practical exercise was performed on December 18th 2007 in two areas of high viral density and one of low viral density. This exercise involved all the people in these areas, without disturbing the normal care activity. Results: Two hundred and forty-five people were evaluated. Seventy-five per cent of whom had been trained in the hospital. Hand hygiene complied with pre-established procedures in 32% of cases, was acceptable in 44%, and deficient in 24%. Surgical mask application was unacceptable in 21% of cases. These precautions were well accepted by 36% of the personnel, accepted by 54%, and a burden for 10%. The poor sealing capacity of mask FFP2 (national allocation), depending on facial features, its poor tolerance, the lack of water stations, and the presence of groups of people were all noted. Conclusion: This exercise was rated as satisfactory with a good participation. However, it revealed unexpected dysfunctions such as application of barrier precautions. Also, that the FFP2 mask was not suitable for all people, especially for children, a problem in case of a pandemic. Finally, this exercise should lead to corrective actions and to completing the various training sessions initiated in other institutions. [Copyright &y& Elsevier]

In emergency situations, a basic public health framework consists of ensuring food and water security, sanitation, access to basic medical care, including mass vaccinations, and disease prevention. [ABSTRACT FROM PUBLISHER]

Les attentats de Paris et Nice ont conduit à réviser les procédures de Plan Blanc concernant notamment la délivrance des PSL aux services d'urgence. Une étude pilote a été menée conjointement avec le CHU de Besançon. Sur 15 mois, 8 réunions se sont tenues en présence des responsables de la qualité du CHU, l'hémovigilance du CHU et la responsable de la délivrance l'EFS, afin de définir les modalités les plus appropriées. La distinction entre Plan Blanc attentat et Plan Blanc hors attentat a été réalisée. Deux lignes du dispositif automatisé sur les 3 existantes ont été dédiées au plan blanc desservant le lieu de prise en charge des urgences absolues et des extrêmes urgences. La 3e ligne sera réservée aux urgences transfusionnelles des autres services de soins pendant toute la durée du Plan Blanc. La prescription simplifiée de PSL, normalement réservée au pré hospitalier, a été étendue aux services de réanimation médicale et chirurgicale et SSPI. Dans les deux types de Plan Blanc, un personnel de l'EFS sera intégré au PC du CHU, afin de renseigner l'EFS sur les victimes et anticiper sur les besoins. Les procédures dégradées en cas de panne du pneumatique ont été décrites. Cette procédure est issue d'une analyse commune qui a permis la gestion de l'interface et de disposer des autorisations préalables qui ont été présentées à l'ensemble des soignants et intégrées dans les procédures du CHU. Ce travail préalable a permis de réviser nos procédures Plan Blanc et de les tester à travers des exercices impliquant l'ensemble des acteurs dans le but de garantir la sécurité transfusionnelle des patients. [ABSTRACT FROM AUTHOR]

Flood risk management for residences requires an economical analysis involving the mean annual damage by floods, taking into account the whole range of probability of floods and the cost of projected fluvial enhancements and measures, taking also into account the residual level of risk. Efficient methods are therefore necessary to estimate these risk values. The proposed approach is of a "distributed" type; it involves numerical modeling for estimating "residential submersion depth", a variable, which explains most of the direct damages to residences. The method relies on an individualized georeferenced definition of each residence. Measured submersion data and the compensations obtained from the huge Saguenay flood in 1996 (Ville de Laterrière) were used to build empirical laws based on submersion. Four distinct relationships were established: residences with or without a basement and valued below or above $50,000 each were assigned a specific relationship. With these relationships, direct residential damages in Laterrière were assessed by using only simulation results at the georeferenced position of sector residences as input. It was then possible to evaluate the total amount of direct home damages in Laterrière. [ABSTRACT FROM AUTHOR]

The initial management of severely head-injured patients, including infants and children, is aimed at preventing and treating secondary brain damage, which mainly result from systemic insults (hypoxaemia, hypercarbia, arterial hypotension). Orotracheal intubation, followed by continuous sedation-analgesia, is mandatory when the Glasgow Coma Scale score (GCS) is less than or equal to 8 (crush induction is recommended). The goal of mechanical ventilation is to maintain normoxaemia and normocarbia. Moreover, the maintenance of an optimal cerebral perfusion pressure, usually 50 mmHg in infants, requires volume loading (isotonic fluids and colloids), and catecholamines if arterial hypotension persists. Intravenous mannitol is used only in case of life threatening intracranial hypertension, keeping in mind the potential for aggravating an hypovolaemia. Cerebral tomodensitometry is the most relevant imaging procedure for diagnosing surgical brain lesion. However, it should be noted, that severe head trauma is frequently associated with extra-cranial traumatic injuries, which may be responsible for (avoidable) deaths if the diagnosis is not made or delayed. Therefore, infants and small children presenting with severe head trauma should be considered as multiple injured and treated accordingly. Adequate initial management of severely head-injured children may participate to improved neurological outcome. [Copyright &y& Elsevier]

As in the case of adults, there are three main goals in the monitoring of severe head trauma in children: to prevent or minimize the apparition of secondary lesions, to optimize treatment, to help make precise prognosis.The basic monitoring is composed of repeated clinical examinations, brain radiological imaging and control of vital parameters (blood pressure, temperature, PaO2 (SpO2), PaCO2 (FETCO2), haemoglobin, haematocrit. On the other hand, during specific brain monitoring, the brain perfusion (TCD, intracranial pressure), the electrical activity of the brain and sometimes the brain oxygenation (SvjO2) are controlled. The data obtained from the brain monitoring must always be interpretated carefully. A child with a severe head trauma, in ICU, always requires constant and competent medical attention. [Copyright &y& Elsevier]

Abstract: The code de santé publique imposes to all health professionals an obligation to declare serious and undesirable events following cares applied during treatment investigations or prevention actions. An experimentation has been installed under the responsibility of the Institut de Veille sanitaire further to the 9 August 2004 bill. It aims to define how to declare undesirable adverse events to test its feasibility, its efficiency and to identify the necessary conditions to widespread its modalities. The field of these experimentations concerns all health professionals, working in public hospital or in private practice. The definition of undesirable adverse events should be clarified. Different ways to declare these events will be discussed with SFRO (Société française de radiothérapie oncologique) to improve the current management of incidents and adverse events. [Copyright &y& Elsevier]

Abstract: The authors report the case of a 23 year old patient, who presented the following combination of injuries after a fall, namely a divergent dislocation of the elbow, a fracture of the radial head, a fracture of the ulna and a perilunate dislocation with scaphoid fracture. The entire injury thus represented a bipolar dislocation of the forearm. The emergency management consisted of a closed reduction of the elbow together with osteosynthesis of the ulna, internal fixation of the scaphoid with a compression screw, and scaphocapitate K wiring. After 26 months, the function of the elbow was satisfactory, and the range of motion of the wrist was from 50° of flexion to 40° of extension. Satisfactory healing of the scaphoid was observed. This combination of injuries has only rarely been reported in the literature. [Copyright &y& Elsevier]