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Resume Depister, reconnaitre et mesurer la douleur s’inscrivent dans les premieres etapes de toute demarche de prise en charge medicale. En pratique clinique, l’evaluation de la douleur est multimodale et repose sur l’expression du patient verbale et non verbale, comportementale. L’analyse du comportement est donc essentielle en particulier dans les situations ou les methodes d’autoevaluations sont inapplicables (patients incapables de s’exprimer verbalement, barriere linguistique, sideration post traumatique, etc.). Une echelle comportementale d’evaluation rapide de la douleur aigue (ECERDA) a ete mise au point : il s’agit d’un score multiparametrique compose d’indicateurs comportementaux, en rubriques restreintes, permettant une cotation rapide et decimale, reproductible, bien correle aux scores deja valides (EVA et EN) permettant le suivi d’un traitement antalgique. La faisabilite clinique de l’ECERDA a ete testee en situation reelle en 2005 lors du seisme au Pakistan. Une etude multicentrique, prospective, validee par un Comite de protection des personnes (CPP), realisee entre 2008 et 2014 a compare l’ECERDA aux echelles de reference en situation de medecine d’urgence, EVA et EN chez l’adulte, EVA, echelle des visages et EVENDOL chez l’enfant, DAN, EDIN, CB chez le nouveau-ne et le nourrisson. Les criteres de jugements etaient la fiabilite, la coherence, la sensibilite aux evolutions et la reproductibilite. Entre 2008 et 2014 sur neuf sites (SMUR adulte et pediatrique, SAU adulte et pediatrique, SSPI, equipe mobile de soins palliatifs) 1782 patients ont ete inclus dont 225 enfants et 157 nouveaux nes et nourrissons, et 6542 cotations realisees. La correlation avec les echelles de reference est de 85 % pour les adultes et 92 % chez les enfants avec une concordance de reproductibilite interoperateurs de 94 %. La facilite de comprehension de l’outil, la courte courbe d’apprentissage, jointe aux performances montrent que l’ECERDA est un outil d’evaluation de la douleur fiable, simple, rapide et facile a utiliser en alternative aux echelles de reference, en particulier pour les patients dans l’incapacite de communiquer. Cet outil apparait donc approprie aux prises en charge en situation de medecine de catastrophe.

Background Recent-onset atrial fibrillation (RAF) is the most frequent supraventricular dysrhythmia in emergency medicine. Severely compromised patients require acute treatment with injectable drugs Objective The main purpose of this external validity study was to compare the short-term efficacy of esmolol with that of amiodarone to treat severe RAF in an emergency setting. Methods This retrospective survey was conducted in mobile intensive care units by analyzing patient records between 2002 and 2013. We included RAF with (one or more) severity factors including: clinical shock, angina pectoris, ST shift, and very rapid ventricular rate. A blind matching procedure was used to constitute esmolol group (n = 100) and amiodarone group (n = 200), with similar profiles for age, gender, initial blood pressure, heart rate, severity factors, and treatment delay. The main outcome measure was the percentage of patients with a ventricular rate control defined as heart frequency ≤ 100 beats/min. More stringent (rhythm control) and more humble indicators (20% heart rate reduction) were analyzed at from 10 to 120 min after treatment initiation. Results Patient characteristics were comparable for both groups: age 66 ± 16 years, male 71%, treatment delay 2 h 35%, chest pain 61%, ST shift 62%, ventricular rate 154 ± 26 beats/min, and blood pressure 126/73 mm Hg. The superiority of esmolol was significant at 40 min (64% rate control with esmolol vs. 25% with amiodarone) and for all indicators from 10 to 120 min after treatment onset. Conclusion In “real life emergency medicine,” esmolol is better than amiodarone in the treatment of RAF.

Pain in children is underestimated and undertreated because of lack of pain assessment tools. Pain assessment depends on the cognitive development of the child being tested, clinical context, and pain typology. For children older than age 6 years, pain assessment is based on a self-report. For children younger than age 6 years, behavioral pain scales are needed to assess pain. Numerous pain scales exist. Many are reliable and some are recommended, but all have specific conditions for their use. In this article, we review the available pain scales for children from birth to adolescence. We provide the validity criteria of each pain scale to help caregivers use the adapted tools. We then propose a synthesis of the reliable tools to use based on the pain context. [ Pediatr Ann. 2017;46(10):e387–e395.]

Purpose: Reversibility and impact of diaphragmatic dysfunction (DD) are unknown. The principal aim was to describe diaphragmatic function as assessed by ultrasonography during weaning trials. Materials and Methods: The present study is a 6-month single-center prospective study. All patients under mechanical ventilation for more than 7 days and eligible for a spontaneous breathing trial (SBT) were enrolled prospectively. Intervention: Two blinded ultrasonographers evaluated each hemidiaphragm during SBT. Prevalence of DD among weaning failure and death and interobserver reproducibility have been evaluated. Results: The 34 included patients had a mean Simplified Acute Physiology Score version II of 55.7 ± 14 and a median intensive care unit (ICU) stay length of 17 days (13-30). Diaphragmatic dysfunction was found in 13 (38%) patients, on both sides in 8. Bilateral DD resolved before ICU discharge in 5 of the 7 reevaluated patients. No weaning failures were recorded. The ICU mortality was higher in patients with DD (37% vs 5%, P = .048). Mean interobserver agreement rate was 91%. Reproducibility was better with M-mode. Conclusion: The ICU-acquired DD usually improves before ICU discharge but might constitute a marker for greater disease severity. The present preliminary results require confirmation in a larger prospective multicenter study.

A regional survey was performed between June and September 2002, to evaluate knowledge and attitudes of emergency physicians regarding adverse drug reaction (ADR) reporting in a French district. 100 questionnaires completed by physicians working in emergency departments and/or mobile intensive care units were analysed.The frequency of ADRs encountered by emergency practitioners was estimated ator = 0.73 per year and per physician. The ADR notification rate in emergency medicine was estimated ator = 6%. A minority of physicians were responsible for the majority of ADR reporting. Sixty-four percent of emergency physicians underestimated the conditions required for ADR notification: 28% thought that certain causality was an absolute necessary condition for notification, while 37% considered that notification was required only for ADRs that were both severe and unexpected.Interventions focused on advertising ADR reporting procedures could help to improve the notification rate in emergency medicine.