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Objectives: To assess the prescribing patterns in acute renal colic in emergency departments in US and France, by comparing physicians' intended prescription practices with actual prescription data in a sample of emergency practitioners.Methods: Pharmaco-epidemiological international study in two phases. First, we surveyed emergency physicians in US and France as to what analgesics they would use for simulated cases of renal colic. We then conducted a retrospective review of actual cases of emergency department patients with pain scores ≥6/10 with acute renal colic during a period of 6 months before the survey. We compared nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids used for pain treatment in the two groups, and the differences between the two countries.Results: One hundred six prescribers and 100 patients were included in the study. Comparison between simulated and real cases showed that NSAIDs and opioids were less frequently prescribed in real life (78% vs 99% and 51% vs 100% respectively). Morphine was the most prescribed opioid (96% of simulated cases and 34% of real ones). Acetaminophen use was increased in real life cases (58% vs 0%). Concerning the differences between countries, US physicians are more likely to administer morphine (64% vs 38%) and French physicians NSAIDs (88% vs 68%). The NSAIDs used are ketorolac in the United States (94% of simulated cases vs 64%) and ketoprofen in France (94% and 88% respectively).Discussion: We showed clear differences between intended and real analgesic prescription practices for patients suffering from renal colic. Some differences exist for pain perceptions and treatments between US and France. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of this study is to describe emergency medicine (EM) publications in terms of methodology, approval by institutional review board, method of consent, external validity, and setting (eg, prehospital or emergency department). METHODS: The 12 top-ranked emergency journals were selected. We manually reviewed the last 30 original articles in each EM journal, to represent more than 2 months of publications for all EM journals (range, 2-6 months). Only clinical original articles on human subjects were included. To ensure accurate data transcription, each article was read at least twice by 2 different reviewers and graded by written criteria using an extraction standard chart. RESULTS: Over the articles reviewed, 330 were analyzed. One hundred eighty-nine (57.3%) were prospective studies; 29 (8.8%) were randomized studies. Two hundred twenty-six studies (68.5%) mentioned an institutional review board approval or a waiver of authorization, and an informed consent was not mentioned in 227 (68.8%) of studies. Fifty-nine (17.9%) were conducted in a prehospital setting. Two hundred thirty-eight (72.1%) of these studies were at single-center institutions; the Unite States contributed 158 (47.9%) of the total publications. CONCLUSION: This study describes publications in the field of EM. Randomized studies represent 9% of publications, most studies are cross-sectional, and more than half have a retrospective design. We found that, in one-third of the studies, an institutional review board review was not mentioned and informed consent was not specified in two-thirds of the studies. Emergency medicine research volume, quality, and grants activity must increase in order for EM to progress within academic medicine. [ABSTRACT FROM AUTHOR]

We assessed the satisfaction of onboard caregivers with the maritime telehealth service provided by the Centre de Consultations Médicales Maritimes (CCMM). We conducted a survey of captains and caregivers by email. Of the 385 surveys sent out, 165 (43%) were completed. Eighty four percent of responders (n = 110) thought that waiting time was satisfactory or very satisfactory, and 97% (n = 128) were satisfied or very satisfied with their relationship with the remote physician. Thirty eight per cent of participants (n = 50) considered that the physician understood the medical problem very well; understanding was good in 58% of cases (n = 76) and bad in only 4% of cases (n = 5). Sixty two per cent of participants (n = 83) sent pictures before consultation. The respondents were also satisfied with the telephone advice overall, the competence of the physicians providing the advice, the length of time spent waiting, the verbal prescription and the medical advice given. Onboard caregivers were generally well satisfied with the maritime teleconsultations and the advice provided by the CCMM physicians. [ABSTRACT FROM AUTHOR]

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Introduction. Overdose of potassium is not as frequently encountered in clinical practice as hyperkalaemia due to acute or chronic renal disease. However, potassium overdoses leading to serious consequences do occur. Case Presentation. A 20-year-old nurse student presented with a cardiac arrest with asystole rhythm. Beside the patient were found four 50-mL syringes and empty vials of potassium chloride (20mL, 10%). After initial resuscitation with epinephrine, 125mL of a 4.2% intravenous solution of sodium bicarbonate were injected which resulted in the recovery of an effective cardiac activity. The patient recovered without sequelae. Conclusion. The difficulty in this case was to recognize the potassium poisoning. The advanced resuscitation with the use of a specific treatment helped to resuscitate the patient. [ABSTRACT FROM AUTHOR]

Objective: To compare the relation between peritraumatic dissociation and acute stress and the early development of posttraumatic stress disorder (PTSD) in victims of general crime.Method: A total of 48 subjects were assessed within 24 hours of the trauma, using the Peritraumatic Dissociative Experiences Questionnaire Self-Report Version (PDEQ-SRV). They were followed longitudinally to assess acute stress (2 weeks after the assault,) using the Standford Acute Stress Reaction Questionnaire (SASRQ), and posttraumatic stress (at 5 weeks), using the Clinician-Administered PTSD Scale (CAPS) and the Impact of Event Scale (IES).Results: Among PTSD subjects mean PDEQ scores were significantly higher (mean 3, SD 0.9) than in those without PTSD (mean 2.3, SD 0.7) (t = 2.78, df 46, P = 0.007). Among PTSD subjects, mean SASRQ scores were significantly higher (mean 97.9, SD 29.2) than in those without PTSD (mean 54.8, SD 28.2) (t = 4.9, df 46, P = 0.00007).Conclusions: High levels of peritraumatic dissociation and acute stress following violent assault are risk factors for early PTSD. Identifying acute reexperiencing can help the clinician identify subjects at highest risk. [ABSTRACT FROM AUTHOR]

Background Identification of the coronary origin of a thoracic pain by the emergency physician in charge of telephone triage at the pre-hospital emergency service is a key element of prognosis. Purpose To build a gender-specific telephone score for predicting ACS for patients calling for non-traumatic thoracic pain. Method Observational multicenter prospective study. Patients ≥18 years old calling the telephone triage center for a non-traumatic chest pain were included. The outcome was ACS diagnosis estimated by two independent experts. Separate models were built for men and women. Multivariable analyses were carried out to identify predictive items of ACS using a stepwise logistic regression. Models performances were assessed (c-statistic). Data were randomly divided into a derivation and a validation sample. Results In three medical centers, 3727 patients were included (2097 men, 1630 women). ACS were diagnosed in 24.2% of men and 8.5% of women. Among men, variables independently associated with ACS were age, smoking, pain intensity, persistence of pain, retrosternal pain, lack of increased intensity with inspiration, pain irradiations, pain association to other signs. The area under the receiver operator characteristic (ROC) curve (AUC) was 0.76 (95% confidence interval (CI) 0.73-0.79). A 48 point score was built. The AUC of the score applied to the validation sample was 0.77 (95% CI 0.73-0.80). Among women, variables independently associated with ACS were age, previous coronary artery disease, lack of increased pain intensity with inspiration, pain irradiations. The AUC was 0.79 (0.75-0.83). A 23 point score was built. The AUC of the score applied to the validation sample was 0.67 (95% CI 0.60-0.74). Conclusion Predictive characteristics of ACS in patients who call medical dispatch centre for chest pain are different for women and men. The predictive accuracy of the models we developed was better among men than women. [ABSTRACT FROM AUTHOR]

The letter discusses a case of using intravenous fat emulsion (IFE) to treat a voluntary intoxication of flecainide with refractory shock. The patient ingested flecainide, oxazepam and levothyroxin. Based on the patient's electrocardiogram, her QRS complexes widened with prolonged QT interval. It is said that Intralipid infusion was administered because of the similarities of flecainide with molecules of the class of local anesthetics.

Summary: Voluntary copper poisoning is a rare mode of suicide. We report a case of copper sulphate poisoning in a patient presenting delusions with mystic demands for purification. The initial gastrointestinal symptoms were followed by intravascular haemolysis and renal failure. The course was favourable after symptomatic treatment and specific copper chelation therapy. However, the pathogenesis is not fully understood and with the present state of knowledge, no one treatment can be said to be superior to another. The authors discuss the various treatments of this rare poisoning through a review of the available literature. [Copyright &y& Elsevier]