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Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Understanding the experiences of families of children with autism spectrum disorder in the context of the Covid-19 pandemic in emergency and urgent care services. Methods: This is a multiple case study with a qualitative, descriptive approach. The collection of evidence took place during the year 2022, in an online manner, with 13 families of children with autism, through semi-structured interviews in a virtual environment. Results: The evidence resulted in two thematic categories: “Pandemic” and “Experiencing urgency and emergency”. The families expressed that the pandemic had a negative impact on their lives and the use of urgent services was also experienced negatively, affecting the child with the disorder, as well as their family, on different levels and aspects. Final considerations: Families are capable of promoting actions that directly refer to the aspect of the resilience process that their members were able to establish during this period.

Les situations de crise sont fréquentes à l'adolescence. Le Dispositif Départemental Réactif pour Adolescents (DDRA31) a été implanté en 2017, en Haute-Garonne, pour offrir rapidement, aux adolescents en crise, une consultation spécialisée de psychiatrie avec un accompagnement de trois mois. Notre objectif était de mesurer l'effet de l'implantation de ce dispositif sur l'évolution de l'incidence annuelle des consultations aux urgences et hospitalisations des adolescents pour motif psychiatrique au CHU de Toulouse, guichet hospitalier unique de leur prise en charge en Haute-Garonne. Nous avons conduit une étude quasi expérimentale mesurant l'évolution avant-après l'implantation du DDRA31, l'incidence annuelle des passages aux urgences (pédiatriques et adultes) et d'hospitalisation pour motif psychiatrique au CHU de Toulouse parmi la file active annuelle de tous les adolescents âgés de 12 à 17 ans révolus, résidant en Haute-Garonne, de 2014 à 2019. Les facteurs associés au risque d'hospitalisation ont été analysés par régression logistique à effet mixte pour mesurer l'effet du dispositif au cours du temps, avec l'année comme variable explicative principale, ajusté sur le sexe et l'âge. De 2014 à 2019, 6686 passages aux urgences, réalisés par 4245 adolescents ont été observés. Le taux annuel d'incidence de passage aux urgences pour motif psychiatrique était stable, passant de 14,0 (IC 95 % : 13,2–14,9) pour 100 adolescents en 2014, à 13,9 (IC 95 % : 13,2–14,7) pour 100 adolescents en 2019. L'incidence annuelle des hospitalisations a diminué significativement de 38,3 (IC 95 % : 34,1–42,8) pour 100 adolescents en 2014 à 24,2 (IC 95 % : 21,2–27,4) pour 100 adolescents en 2019. La modélisation du risque d'hospitalisation montrait une réduction significative à partir de 2017, avec un rapport de cotes passant de 0,63 (IC 95 % : 0,49–0,80) en 2017 à 0,52 (IC 95 % : 0,41–0,67) en 2019. Nous n'avons pas montré d'effet du dispositif sur l'incidence annuelle du passage aux urgences pour motif psychiatrique mais un effet possible sur la réduction du risque d'hospitalisation en psychiatrie, suite à un passage aux urgences. La mise en place de structures ambulatoires réactives pourrait diminuer la sollicitation de services d'hospitalisation sous tension. Crisis situations are common during adolescence. Current data show that adolescents in crisis are either directly referred to hospital psychiatric emergency rooms, or they make an appointment for a specialized consultation, in a medical-psychological center (CMP), in a medical-psychological-pedagogical center (CMPP), or with a private practitioner. The Departmental Reactive System for Adolescents was implemented in 2017 in the French department of Haute-Garonne to provide adolescents in crisis an immediate specialized psychiatric consultation including on-going support for three months. Our objective was to measure the effect of the implementation of this health system organization (HSO) on the evolution of the annual incidence of emergency room visits and hospitalizations of adolescents for psychiatric reasons at the Toulouse University Hospital, the sole facility for such care in Haute-Garonne. We conducted a quasi-experimental study comparing the evolution, before and after the implementation of the DDRA31, the annual incidence rates of emergency room visits (pediatric and adult) and hospitalizations related to mental health at the Toulouse University Hospital for adolescents aged 12 to 17 years of age, residing in Haute-Garonne, from 2014 to 2019. Factors associated with the risk of hospitalization were analyzed using mixed-effects logistic regression to measure the effect of the system, over time, with the specific year as the primary explanatory variable, adjusted for sex and age. From 2014 to 2019, 6 686 emergency room visits by 4 245 adolescents took placefor psychiatric motives or diagnostics. The annual incidence rate of emergency department visits related to mental health was stable from 14.0 (95 % CI: 13.2–14.9), per 100 adolescents in 2014 to 13.9 (95 % CI: 13.2–14.7) in 2019, with a higher incidence rate for girls and adolescents aged from 15 to 17 years old. The main reasons for emergency room visits were behavioral problems or agitation, drug intoxications or suicide attempts, and drug or alcohol use or abuse. The annual incidence of hospitalizations decreased significantly since 2017, from 38.3 (95 % CI: 34.1–42.8) per 100 adolescents in 2014 to 24.2 (95 % CI: 21.2–27.4) per 100 adolescents in 2019. This decrease was shown for both males and females but only for adolescents aged from 15 to 17 years old, from 21.8 (CI 95 %: 17.9–26.1) in 2014 to 2.6 (CI 95 %: 1.5–4.1) in 2019. Modeling of the hospitalization risk showed a significant reduction from 2017 onward inclusive with an odds ratio ranging from 0.63 (95 % CI: 0.49–0.80) in 2017 to 0.52 (95 % CI: 0.41–0.67) in 2019. The fact that an impact of the HSO was found only for adolescents aged 15 to 17 years of age could indicate a selective effectiveness depending on age possibly caused by differences in physician attitudes depending on the age of the patient. The chronology of changes in hospitalization rates after a visit to the emergency room corresponded to the period when the HSO was implemented, whereas hospitalization rates were stable over the three years prior to its implementation. The main limitations of our study were the absence of data regarding emergency department diagnoses and discharge modes for the year 2019 and the lack of a temporal perspective. Our study did not show any significant effect of the HSO on the annual incidence of emergency room visits related to mental health, but there was a possible effect on reducing the yearly incidence rate and the risk of hospitalization of adolescents in psychiatric services following an emergency room visit. The implementation of reactive ambulatory structures could therefore reduce the demand on hospitalization services that are under pressure. [ABSTRACT FROM AUTHOR]

House calls are an important part of medical practice in Switzerland and help reducing the need for emergency room visits. To ensure quality service, the content of the doctor' s bag must be adapted to home practice: Enough to deal with a variety of clinical situations, while sufficiently limited to remain portable. We offer here an updated doctor' s bag content, focusing on the resources needed for diagnosis and treatment. We distinguish between basic items and additional resources that can be used for extended care, particularly in regions with no local health resources. [ABSTRACT FROM AUTHOR]

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cogitare Enfermagem is the property of Cogitare Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article summarises learning from Southern-led research designed to infuence the response to the Covid-19 pandemic. The case studies are drawn primarily from the Covid-19 Responses for Equity (CORE) programme, funded by the International Development Research Centre (IDRC). The article examines: (1) the characteristics of local research institutions' organisational readiness in times of crisis; (2) the form and function of knowledge that is ft for purpose in emergencies; and (3) knowledge processes and engagement strategies for rapid mobilisation. Organisational readiness hinged on the strength of research institutions' networks, access to key decision makers or afected communities, and resources and capabilities that allowed them to mobilise quickly. Hyper-local knowledge, combined with inclusive research methodologies, facilitates the positioning of research for use in emergencies. The pandemic has demonstrated that local and national research organisations are well placed to deliver impactful research, as both critical friends of government or outsiders advocating for change. [ABSTRACT FROM AUTHOR]

Au Congo, la nécessité d’un cadre juridique protecteur de la femme enceinte est une préoccupation. En effet, le risque que court une femme de mourir ou de devenir invalide durant la grossesse et l’accouchement est en rapport étroit avec son statut social et économique, les normes et valeurs de la culture à laquelle elle appartient et le fait de résider dans un lieu géographique reculé. De manière générale, plus une femme est pauvre et marginalisée, plus son risque de mourir est grand. En fait, les taux de mortalité maternelle reflètent les inégalités entre pays riches et pays pauvres dont fait partie le Congo, plus qu’aucune autre mesure d’ordre sanitaire. Ici, le risque d’une femme, calculé sur la durée de vie, de mourir du fait de la grossesse ou de l’accouchement est de 1 sur 39 contre 1 sur 4 700 dans les pays développés.

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Outpatient treatment (OT) of patients with low-risk pulmonary embolisms (PE) is recommended. A multidisciplinary OT program including the general practitioner (GP) has been implemented at Versailles hospital in 2019. The objectives of the study were to assess the feasibility, safety and acceptability of the program. The feasibility of, and the inclusion criteria for OT were defined from a retrospective cohort study of PE patients carried out in 2018. In the prospective study, consecutive patients consulting in the emergency department between 2019 and 2021 with confirmed PE were eligible for OT if they had sPESI and HESTIA scores equal to 0, normal troponin and NT-pro-BNP levels, and no right ventricular dilation on imaging. PEs associated with COVID were excluded. The OT program included 4 appointments within 3 months, including 2 with the GP. Events (death, recurrence of PE or venous thromboembolism, bleeding, rehospitalisation) were collected at 3-month follow-up. In the retrospective study, 19% of the 138 PE patients seen in the emergency department were eligible for OT. No complication occurred at Day 90. In the prospective study, 313 consecutive patients with confirmed PE in the emergency department were included, 66 (21%) were eligible for OT. Overall, 43 patients (14%) received OT (39 eligible) and 27 patients eligible for OT were hospitalised (92% because of pulmonary infarction). At 3-month follow-up, there were no death, no recurrence of thromboembolism, and one patient has been early hospitalised for COVID; 3 female patients treated with rivaroxaban had minor bleeding (heavy menstrual bleeding). The satisfaction rate of general practitioner was 95%. This study confirms the feasibility and safety of our OT program for low-risk EP patients, centered on the general practitioner. It reduces the time spent in the emergency department, reduces hospitalisations and strengthens the city-hospital link for care. [ABSTRACT FROM AUTHOR]

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: the objective of this work was to establish the clinical profile of patients consulting in gyneco-obstetrical emergencies and identify the reasons for consultation and the becoming of the consultants. Methods: a one-center retrospective descriptive observational study was performed including patients who consulted between January 1st and December 31st, 2018. Obstetric emergencies after 36 weeks of amenorrhea were not included. We drew lots 4 months of the year 2018 (one month per season). Then we drew lots 2 weeks of each month. A data collection sheet was developed for the purposes of this work. Results: a total of 2007 patients were included in our study among 15,553 gynecological emergency room consultants during 2018. We found that the largest number of consultants was recorded at the start of the week and between 7 am and 7 pm. The most frequently obstetric reasons observed for consultation were pelvic pain (39.6%), bleeding (23.8%) and vomiting (8.7%). The most frequently gynecological reasons for consultation were pelvic pain (54.2%), then metrorrhagia (18.8%) and mastodynia (7.1%). Of the study participants, 66.82% received an ultrasound, 23% received a beta HCG test. The majority of emergency room consultants were referred to their home. Conclusion: the majority of patients visiting the emergency room do not have any emergencyrelated pathologies. [ABSTRACT FROM AUTHOR]

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: Le développement des filières gériatriques permet une hospitalisation en entrée directe évitant le passage par les urgences. À Clermont-Ferrand, depuis 2011, une ligne téléphonique dédiée permet une régulation des entrées. L'objectif de cette étude est d'évaluer l'impact du mode d'entrée (directe ou urgences) sur la durée moyenne de séjour (DMS) chez les patients hospitalisés en court séjour gériatrique (CSG). Méthodes: La DMS, ainsi que les données socio démographiques, le score d'autonomie, le MMS, les comorbidités, le mode de sortie, la survenue d'une hospitalisation dans l'année précédente et la polymédication ont été recueillis de manière rétrospective chez les patients âgés de plus de 75 ans. Résultats: 272 patients ont été inclus (88 « entrées directes » et 184 « urgences »). Les caractéristiques des groupes étaient comparables. La durée médiane de séjour pour le groupe « urgences » était de 14 [9,5 ; 20] contre 12 [8,5 ; 18] pour l'autre groupe (p = 0,03). En analyse multivariée, le score d'ADL et le mode de vie étaient corrélés à la DMS avec respectivement p = 0,009 et p = 0,018. Conclusion: La création de filières d'entrées directes en CSG par la mise en place de lignes téléphoniques dédiées permet une réduction de la DMS. Introduction: Development of the geriatric care allows direct hospitalization and avoid unnecessary emergency admissions. In Clermont-Ferrand, a specific hotline regulates direct entry from home and emergencies in the geriatric acute care unit. The aim of this study was to evaluate the impact of the entry mode (home or emergency) on the length of stay of patients hospitalized in acute care geriatric unit. Materials and methods: We have retrospectively collected data on hospitalization of patients over 75 years in the Geriatric Acute care unit from January to March 2019. We also collected socio-demographic data, autonomy score, MMS, co-morbidity score, exit mode, previous year's hospitalization and polymedication on hospitalization reports. Results: We included 88 patients in the "direct" group and 184 patients in the "emergency" group. The characteristics of the two groups were comparable. The median length of stay for the "emergency" group was 14 days [9.5; 20] versus 12 [8.5; 18] for the "direct" group (p=0.03). In multivariate analysis, ADL score and home lifestyle were correlated with duration of stay. Conclusion: The development of direct entrance pathways into the geriatric short-stay department by establishing specific hotlines decreases length of stay. [ABSTRACT FROM AUTHOR]

L'anaphylaxie est une urgence médicale de plus en plus fréquente, notamment chez l'enfant et pour les causes alimentaires. Les principales étiologies d'anaphylaxie sont les aliments (notamment l'arachide, les fruits à coque, les laits de mammifères) chez l'enfant et, chez l'adulte, les venins d'hyménoptères et les médicaments. La mortalité par anaphylaxie reste cependant rare. D'après toutes les recommandations scientifiques, l'adrénaline administrée par voie intramusculaire pour toutes les situations en dehors de l'urgence périopératoire est le traitement de première ligne de l'anaphylaxie. L'injection doit être réalisée dès les premiers signes d'anaphylaxie, dans la partie moyenne de la face antéroexterne de la cuisse. Les auto-injecteurs d'adrénaline permettent une administration sécurisée, par tous, y compris les soignants, dans le contexte de l'urgence. Les autres traitements (antihistaminiques, bronchodilatateurs inhalés, etc.) sont de deuxième voire de troisième ligne. Les corticoïdes n'ont pas fait la preuve de leur intérêt dans le traitement de l'anaphylaxie. La surveillance en milieu hospitalier avec un monitoring étroit est au minimum de 6 à 8 heures en cas de résolution rapide des signes ; elle doit être cependant prolongée 24 heures en cas d'atteinte respiratoire ou cardiovasculaire initiale plus sévère. Les réactions biphasiques ou réfractaires à l'adrénaline sont rares. Après la phase de soins médicaux aigus, la prise en charge d'un patient avec une anaphylaxie aux urgences implique aussi la prescription d'une trousse d'urgence avec des auto-injecteurs d'adrénaline et une notice d'utilisation, en accord avec les recommandations, une éducation thérapeutique a minima avec la manipulation de dispositifs factices, et l'orientation vers une consultation d'allergologie avec, dans l'idéal, une filière de soins organisée. [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]

Résumé: La prise en charge des symptômes psycho-comportementaux liés à la démence (SPCD) est complexe et peut nécessiter un recours à un Service d'accueil et d'urgences (SAU). Cette étude a pour objectif principal d'évaluer, au niveau national, les pratiques des médecins urgentistes dans la prise en charge des SPCD, leurs connaissances et leurs compétences dans ce domaine. Cette étude observationnelle et quantitative a été réalisée entre mars 2021 et juillet 2021, au moyen d'un questionnaire en ligne auprès de l'ensemble des médecins travaillant dans un SAU en France. Parmi les 188 urgentistes ayant répondu, 72,9 % se disent confrontés souvent ou très souvent à des patients présentant des SPCD, et 82,5 % déclarent avoir peu ou aucune connaissance concernant les SPCD. La prise en charge choisie en première intention est non médicamenteuse pour 63,3 % des répondants. Quand elle est médicamenteuse, les benzodiazépines de demi-vie courte sont préférées. On note l'utilisation, non négligeable, de neuroleptiques de première et deuxième générations et d'antihistaminiques. Il semble exister une bonne connaissance, par les urgentistes, des filières dédiées aux SPCD, mais peu d'entre eux y ont recours. Cette étude encourage donc la formation des urgentistes à cette problématique et le développement des filières dédiées aux SPCD. The management of behavioral and psychological symptoms of dementia (BPSD) is complex and may fall back on an Emergency Department (ED). The main objective of this study is to review the practices of French emergency physicians for the management of BPSD, their knowledge and their skills in this domain. This observational and quantitative study was performed between March 2021 and July 2021, using an online questionnaire, among all doctors working in ED in France. Among the 188 respondents, 72.9% declared that they were often or very often confronted with patients with BPSD, and 82.5% declared that they had little or no knowledge of BPSD. The first-line treatment was non-pharmaceutical for 63.3% of the respondents. When medication was used, short half-life benzodiazepines were preferred. There was also a significant use of first- and second-generation neuroleptics and antihistamines. Emergency physicians seemed to have a good knowledge of the pathways dedicated to BPSD, but few resort to them. This study therefore promotes the formation of emergency physicians to BPSD and the development of dedicated departments. [ABSTRACT FROM AUTHOR]

Introduction: Emergency Department (ED) overcrowding is a major healthcare issue. The purpose of this study is to determine the causes of emergency department overcrowding and to evaluate intra-hospital transfer after initial treatment. Methods: we conducted a 1-year prospective study at the Emergency Reception Service of the Gabriel Touré University Hospital. All patients admitted to the Emergency Reception Service and belonging to classes 3, 4, 5 of the Clinical Classification of Emergency patients (CCEP) and whose length of stay in the department was greater than or equal to 24 hours were included in the study. Patients consulting the Emergency Department and classified as CCMU classes 1, 2, patients without a well-established medical record and patients who died before treatment were excluded by the study. Results: we recorded 19.571 calls to the emergency service, including massive influxes (a remarkable 44 times, 570 patients). Bed occupancy rate was 108.03% in our department; at the same time, the average bed occupancy in the Hospital was 56%. According to the CCEP classification, 83.75% of patients were CCEP3. Patients with neurological disorders were 557. Patients with a trauma accounted for 56.7%, compared with 49.2% of medical disorders encountered. Conclusion: the average length of stay was 63.59 hours, with a maximum length of 45 days. More than a quarter of the reasons for delayed intra-hospital transfers were due to the need for specific surveillance or specific treatments that were not feasible in conventional hospitalization. [ABSTRACT FROM AUTHOR]

Background: Malaria, a life-threatening parasitic disease transmitted to humans by the female Anopheles mosquito is one of the infectious causes of fever in children. In Nigeria, malaria remains one of the most important health problems, accounting for 25% of infants and 30% of under-five mortalities. The objective of this study was to determine the prevalence of malaria among febrile children presenting at the children's emergency room (CHER) of a tertiary health facility in Abakaliki using a malaria rapid diagnostic test (mRDT). Methodology: This was a retrospective study that involved children presenting with fever in CHER over a 3-year period. A total of 1,273 febrile children below 18 years of age were tested with a malaria rapid diagnostic test (mRDT) kit during this period. Medical records of the patients were assessed to retrieve information such as age, gender, and clinical diagnoses. Data were analyzed using SPSS version 25. Results: A total of 707 (55.5%) were males and 883 (69.4%) were below 5 years of age. The overall prevalence of malaria by the mRDT test was 26% (n=331). Uncomplicated malaria, 283 (22.2%) was the commonest clinical diagnosis made while the least was malnutrition 3 (0.2%). Children aged 10-<18 years were predominantly affected as mRDT positivity rate was significantly higher in children age group 10-<18 years (40.4% 76/189) than other age groups (X2=44.76, p<0.001). Similarly, the rate was significantly higher (OR 9.625, 95% CI 7.233-12.808, p<0.0001) in children with the clinical diagnosis of malaria (55.2%, 235/426) than those with the clinical diagnosis of other illnesses (11.3%, 96/847), and significantly higher (OR 0.19, 95% CI 0.1186-0.3043, p<0.0001) among those clinically diagnosed with complicated (79.7%, 114/143) than those with uncomplicated malaria (42.8%, 121/283). Conclusion: There is a high prevalence of malaria among febrile children presenting at the CHER of Alex Ekwueme Federal University Teaching Hospital Abakaliki. Children age group 10-<18 years were predominantly affected. The use of mRDT should be encouraged both as a screening and diagnostic tool with a protocol such that febrile children who have positive results are confirmed as having malaria while those with negative results are further evaluated with microscopy. [ABSTRACT FROM AUTHOR]

Le but de cette étude est d'identifier les spécificités des motifs de leurs admissions afin de mieux définir les besoins de cette tranche d'âge pour une meilleure organisation de leur accueil et accompagnement en situation d'urgence. Une enquête transversale descriptive auprès d'adolescents consultants au service des urgences pédiatriques de l'hôpital d'enfant de Rabat a été réalisée durant un mois du 1er août au 1er septembre 2018. L'analyse des données a retrouvé un taux de passage de 12 %, un âge moyen de 13 ans avec un sexe ratio de 1,31. Un tiers des patients ont consulté entre 8 heures et 15 heures avec un taux d'autoréférence de 63,2 %. Les motifs médicaux étaient les plus fréquents avec un délai de consultation moins de 24 heures dans 60 % des cas. Deux motifs principaux de recours se sont dégagés : le traumatisme et la douleur. Les accidents représentaient 27,7 %, les affections organiques non accidentelles 66,7 % et les problèmes de santé mentale 5,6 %. Seuls 31 % des cas ont été hospitalisés au terme de leur consultation. Au travers de l'étude, les adolescents au Maroc utilisent les services d'urgences comme source de soins primaires et leur motif de recours reste superposable à celle de la médecine de ville. La présente étude a été réalisée avant l'avènement de la pandémie du COVID 19. The aim of this study is to identify the specificities of admission reasons in order to better define the needs of this unit. age for a better organization of the reception of teenagers in emergency situation. A descriptive cross-sectional surveys of a sample of 408 adolescents in the pediatric emergency department of the Rabat Children's Hospital was carried out during a month from August 1 to September 1, 2018. Analysis of the data found a passage rate of 12 %, an average age of 13 years with a sex-ratio of 1.31. A third of patients consulted between 8 :00 a.m. and 3:00 p.m. with a self-referral rate of 63.2 %. Medical reasons were the most frequent with a consultation period of less than 24 hours in 60 % of the cases. Two main grounds for recourse emerged: trauma and pain. Accidents represented 27.7 %, non-accidental organic ailments 66.7 % and mental health problems 5.6 %. Only 31 % of cases were hospitalized after their consultation. Throughout the study, adolescents in Morocco use emergency services as à source of primary care and their reasons for seeking help overlap with that of city medicine. [ABSTRACT FROM AUTHOR]

Résumé: Objectif. Décrire les caractéristiques cliniques et le devenir d'un groupe de patients de plus de 65 ans adressés en psychiatrie de liaison pour un motif addictologique dans des services d'urgences d'un CHU. Méthodes. Un groupe de 39 sujets âgés de plus de 65 ans (âge moyen : 70,4 ans, 56 % d'hommes) a été comparé à un groupe de 613 patients âgés de moins de 65 ans (âge moyen : 42,0 ans, 69 % d'hommes), adressés consécutivement en psychiatrie de liaison entre mars 2017 et décembre 2020 dans les suites de leur passage dans les services d'urgences du CHU d'Amiens. Résultats et conclusions. Les principaux motifs d'admission étaient les intoxications éthyliques aiguës (54 %), les troubles dépressifs (23 %), les comportements suicidaires (24 %), sans différence significative avec le groupe de moins de 65 ans. La fréquence des fumeurs quotidiens de tabac était moins élevée dans le groupe de sujets âgés de plus de 65 ans (respectivement 28 % versus 71 % ; p < 0,0001). Les fréquences des consommateurs quotidiens d'alcool, des patients présentant des troubles dépressifs, des troubles de personnalité, des patients recevant des antidépresseurs, benzodiazépines et hypnotiques étaient comparables dans les deux groupes. La prescription de médicaments d'aide à l'arrêt du tabac et d'alcool ne concernait qu'un patient sur dix. Background and objective. To describe the clinical characteristics and the outcomes of a group of elderly patients referred to a liaison psychiatry department in the emergency department of an Academic University Hospital. Methods. A group of 39 patients aged over 65 years (mean age: 70. years, 56% male), consecutively referred to a liaison psychiatry department between March 2017 and December 2020, was compared to a group of 613 patients aged under 65 years (mean age: 42.0 years, 69% male) following their admission to the emergency department of the Amiens University Hospital, France. Results and conclusions. The main reasons for admission in the emergency department were alcohol intoxication (54%), depressive symptoms (23%), and suicidal ideas or behaviors (24%), without significant difference with the group of patients aged under 65 years of age. The rate of patients smoking tobacco on a daily basis was lower in the group of patients over 65 years of age (respectively 28% versus 71%, P < 0.0001). The rates of patients who used alcohol on a daily basis, patients with current depressive disorders, patients with personality disorders, patients receiving antidepressants, benzodiazepines or hypnotic treatments were similar in both groups. The prescription of pharmacological treatments for smoking cessation and for alcohol cessation should be enhanced. [ABSTRACT FROM AUTHOR]

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Résumé: Une revue systématique de la littérature a été menée pour lister les facteurs de risque de réadmission aux urgences chez les personnes de 75 ans et plus. Cette revue montre que certains facteurs socio-démographiques (âge élevé, sexe masculin, ne pas être célibataire), certaines comorbidités (pathologies cardio-respiratoires, diabète, altération cognitive, cancer, dépression), les antécédents de chute et la présence d'une altération d'autonomie avant l'admission sont davantage des facteurs de risque de réadmission aux urgences que la cause elle-même d'admission ou sa gravité chez les personnes de 75 ans et plus. Il reste à déterminer le meilleur score prédictif de réadmission chez les plus âgés et à déterminer si un repérage systématique des facteurs de risque associé à une prise en charge spécifique des sujets âgés à risque peut réduire le risque de réadmissions après un premier passage aux urgences. A systematic review of the literature was carried out to assess the risk factors for readmission to the emergency room in people aged 75 and over. This review shows that some socio-demographic factors (high age, male gender, not being single), some underlying conditions (cardio-respiratory diseases, diabetes, cognitive impairment, cancer, depression), a recent history of falling and an impaired autonomy before admission are risk factors for readmission to the emergency room more than the cause of admission itself or its severity in people aged 75 and over. It remains to determine the best predictive readmission score in the elderly and whether a systematic identification of risk factors associated with specific management in the at-risk oldest reduce their readmission after a first visit to the emergency room. [ABSTRACT FROM AUTHOR]

L'objectif de cette étude est d'évaluer les performances diagnostiques de la troponine I hypersensible (hs) pour prédire l'origine cardiaque d'une syncope. L'objectif secondaire est de recherche les causes de majoration de la troponine I hs. Étaient inclus les patients hospitalisés avec un diagnostic principal de malaise ou syncope au SAU. Les performances diagnostiques pour prédire l'origine cardiaque ont été évaluées et comparées au groupe à « haut risque » défini par les recommandations de l'« European Society of Cardiology » (ESC) de 2018. Parmi les 163 patients inclus, 26 % avaient une origine cardiaque. Une troponine I hs positive prédisait une origine cardiaque avec une sensibilité de 31 %, une spécificité de 80 %, des valeurs prédictives positive de 35 % et négative de 77 %. Ces performances diagnostiques sont peu discriminantes et inférieures à la classification de l'ESC. En revanche, un taux de troponine I hs positif est associé à 5 fois plus de décompensation cardiaque durant l'hospitalisation. Une troponine I hs positive lors d'un(e) malaise/syncope n'est pas prédictive d'une origine cardiaque. En revanche, elle semble être un marqueur précoce de remodelage ventriculaire et de l'insuffisance cardiaque. The objective of this study is to evaluate the diagnostic accuracy of high-sensitivity (hs) troponin I to predict cardiac origin after syncope. The secondary objective is to determine the causes of elevated troponin. Were included hospitalized patients with syncope/near syncope diagnosed in ED. The diagnostic accuracy to predict cardiac origin was evaluated and compared to the "high risk" group, defined by the 2018 European Society of Cardiology guidelines. A total of 163 patients were enrolled, 26% had a cardiac origin. Positive troponin I hs predict a cardiac origin with a sensitivity of 31%, a specificity of 80%, positive predictive value of 35% and negative value of 77%. These diagnostic performances are not discriminating and lower than the ESC classification. A positive troponine I hs level is associated with 5 times more cardiac failure during the hospitalization. A positive troponin I hs level after syncope/near syncope is not predictive of cardiac origin. It appears to be an early marker of ventricular remodeling in heart failure. [ABSTRACT FROM AUTHOR]

Résumé: Objectif : évaluer l'impact des activités de pharmacie clinique sur le taux de ré-hospitalisations, non programmées, des patients âgés (75 ans ou plus) admis à la médecine d'urgence de la personne âgée (MUPA) pour chute. Méthode : étude pilote, longitudinale et comparative (groupe bénéficiant des activités de pharmacie clinique et groupe contrôle). Critères de jugement : taux de ré-hospitalisation non programmée au CHU de Limoges à 90 jours (principal), 30 jours, 72 h (secondaires) et estimation des coûts économisés associés. Résultat : 252 patients inclus. Une diminution significative du taux de ré-hospitalisations a été retrouvée à 90 jours (odds ratio = 0,45 (IC95 % 0,26–0,79) p = 0,005), 30 jours (p = 0,035) et 72 h (p = 0,041) dans le groupe intervention. Une moyenne de 37 770 euros sur les 5 mois et demi de l'étude ont été économisés (21 ré-hospitalisations évitées). Conclusion : nos résultats soulignent l'impact positif de la pharmacie clinique sur la prévention des ré-hospitalisations non programmées chez les sujets âgés chuteurs. To evaluate the effect of clinical pharmacy interventions on the unplanned rehospitalizations rates of elderly people admitted for fall to the elderly emergency medicine (EEM) unit in a teaching hospital. Design and measures: This was a longitudinal, comparative pilot study. Patients aged at least 75 who were admitted to the EEM unit for a fall and who had at least two chronic diseases and who were being treated with two or more medications were included from February 1, 2018 to June 30, 2018 and followed by 90 days. The main outcomes were the unplanned rehospitalizations rate at Limoges Teaching Hospital within the 90 days (primary outcome), 30 days and 72 hrs. The estimated cost-saving was also assessed. Results: We included 252 patients. The mean age was 88.4 ± 5.8 years and the average baseline number of medications was 8.3 ± 3.4. In total, 158 pharmaceutical interventions were performed, reflecting an acceptance rate of 94.9%. We found a significant reduction of the rate of unplanned rehospitalizations at 90-day (OR = 0.45 (0.26–0.79) p = 0.005). These results were still consistent at 30-day (p = 0.035) and 72 hours (p = 0.041). We found a cost-saving of 37,770 euros related to 21 avoided rehospitalizations. Conclusions: Our results highly emphasize the positive effects of clinical pharmacy services on the prevention of unplanned rehospitalizations of old adults admitted for fall. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the anesthetic practice in the operating theater of gynecological and obstetric emergencies. Material and method: Prospective, descriptive and analytical study on patients admitted to the operating room for a gynecological and or obstetric emergency over a period of six months. Results: We collected 3,486 patients out of 7,574 admissions, or 46.02%. The average age was 27.3 years with extremes of 15 and 45. SFA was the first operative indication for obstetric emergencies while gynecological emergencies were dominated by first trimester bleeding. 99.39% of the patients benefited from a CPA and 45.40% of them, were classified ASA I u. LAR by spinal anesthesia was the most commonly performed anesthetic regimen. Maternal lethality was 0.005. For the mother, the age group [30-45 years], the provenance, the hemorrhagic syndromes, the ASA III and IV classes, the long delays in transfusion and block management were factors of poor prognosis. (P=0.05) For the fetus, hemorrhagic syndromes and general anesthesia were factors of poor prognosis. (P = 0.05). Conclusion: Spinal anesthesia was the most widely used anesthetic regimen. [ABSTRACT FROM AUTHOR]

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Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Overcrowding in Emergency Departments is often considered as an outcome of insufficient access to hospital beds or primary care, therefore a potential lack of health resources. We sought to describe the quantitative evolution of health resources in the French health care system, in comparison with demographic and epidemiologic parameters that reflect health needs. Overall, in the last decade, parameters of capacity and human resources stagnated while activity and spending increased jointly, stimulated by ageing of the population and chronic diseases mostly. Nevertheless, recent official previsions have again recommended to proceed with hospital bed reduction until 2030. This has led to a dangerous saturation of emergency care and to the ongoing systemic health crisis. This situation will require ambitious health resources reinforcement plans in both hospital and primary care. Furthermore, ageing of the population and chronic diseases must lead society to deliberate on the fundamental goals and funding of our health care system. [ABSTRACT FROM AUTHOR]

Ocular complications of giant cell arteritis (GCA) can lead to irreversible bilateral blindness and represent a therapeutic emergency. Recommendations for the management of GCA have recently been updated. The objective of the study was to evaluate delays in appropriate management of the ocular complications of GCA and its determinants. Retrospective, monocentric study, conducted over the period January 2013–November 2018. All consecutive patients with a final diagnosis of GCA and related visual impairment (permanent visual loss and/or alteration of visual field) were included. Thirty-three patients were included (women: 21, men: 12; mean age at diagnosis: 79). Twenty-seven patients (82%) presented with symptoms suggestive of ACG prior to the visual complication, ranging from a few weeks to several months. Seventeen patients (52%) had a known biological inflammatory syndrome (median CRP at 64 mg/L) prior to hospital consultation. The median time from the onset of permanent ophthalmologic manifestations to appropriate corticosteroid management was 3 days (range: 0–134). Two of the 21 patients who consulted an out-of-hospital ophthalmologist received corticosteroid therapy before referral to hospital. Three patients (9%) were treated within 24 h of the onset of the disorders. There is a significant delay in the appropriate management of ophthalmological complications of ACG and deviations from current recommendations. Numerous actions must therefore be taken to improve the visual prognosis of patients with ACG, both preventively (i.e. early diagnosis and treatment of ACG before the possible occurrence of visual complications), and curatively (rapid recognition and immediate treatment of ocular complications). These elements support the relevance of specific fast-track pathways for GCA. [ABSTRACT FROM AUTHOR]

L'invagination intestinale aiguë est avec la cause la plus fréquente d'occlusion intestinale chez le nourrisson et l'enfant de moins de 3 ans avec une incidence est de 20/100 000. Elle se définit par l'incarcération d'un segment intestinal et de son mésentère dans le segment immédiatement adjacent, constituant une ischémie progressive qui, en l'absence de traitement, évolue vers la nécrose digestive. Elle constitue une urgence thérapeutique. La triade clinique classique associe douleurs abdominales, vomissements et rectorragies, mais elle n'est présente que dans 20 à 30 % des cas. Une grande vigilance du clinicien est donc nécessaire face aux présentations non typiques, qui ne doivent pas être responsables d'un retard de prise en charge. Le diagnostic d'invagination intestinale aiguë est confirmé par une échographie. Le traitement consiste en une réduction par un lavement thérapeutique, en l'absence de contre-indication. En cas d'échec ou de contre-indication du lavement, une intervention chirurgicale est réalisée. Elle permet une réduction de l'invagination, mais peut nécessiter une résection intestinale en fonction du degré d'ischémie. L'invagination est idiopathique dans près de 90 % des cas. Une réduction impossible au lavement ou des récidives multiples doit faire rechercher une lésion anatomique locale : diverticule, polype, hématome... Les suites sont habituellement simples, faisant de cette pathologie une affection bénigne dans notre pays, en l'absence de retard diagnostique et thérapeutique. Intestinal intussusception is the most common cause of intestinal obstruction in infants and children under 3 years of age. It is defined as the incarceration of an intestinal segment and its mesentery in the immediately adjacent segment, leading to a progressive ischaemia which progresses to intestinal necrosis if reduction is not realized. It, thus, constitutes a therapeutic emergency. The classic clinical triad combines abdominal pain, vomiting and bloody stool, but is present in only 20 to 30 % of cases. The clinician must therefore be very vigilant with regard to non-typical presentations, which must not be responsible for a delay in treatment. The diagnosis of intestinal intussusception is confirmed by ultrasound. Treatment consists of reduction by therapeutic enema, in the absence of contraindications. If the enema fails or is contraindicated, surgery is performed. It allows a reduction of the intussusception but may require an intestinal resection, depending on the degree of ischemia. The intestinal intussusception is idiopathic in nearly 90 % of cases. If reduction is impossible or in case of multiple recurrences, a local anatomical lesion must be sought: diverticulum, polyp, haematoma, etc. The consequences of intussusception are usually simple, making this pathology a benign condition in our country, in the absence of diagnostic and therapeutic delays. [ABSTRACT FROM AUTHOR]

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION : l'Insuffisance Cardiaque Aiguë (ICA) correspond à une entité syndromique spécifique, regroupant plusieurs tableaux cliniques hétérogènes; fréquemment rencontrées aux urgences. L'objectif de cette étude a été de décrire les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques des patients admis aux urgences pour ICA.Méthodes: nous avons mené une étude prospective descriptive dans un service d'accueil des urgences qui a inclus tous les patients admis pour ICA. Nous avons étudié les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques chez ces patients.Résultats: nous avons inclus 180 patients pour ICA ayant entrainé une hospitalisation dans le service d'urgence. Le sexe ratio a été de 1,27. L'âge moyen a été de 66±12 ans. Quatre vingt deux pour cent des patients étaient hypertendus et 69% étaient diabétiques connus. Les étiologies de décompensation étaient essentiellement une poussée hypertensive chez 61,7% des patients, un syndrome coronaire aigu chez 24%. Le support respiratoire a été assuré essentiellement par la CPAP (Continuous Positive Airway Pressure) dans 73,3% des cas. Le traitement pharmacologique a été à base de dérivés nitrés dans 70% et de diurétique dans 40,5% des cas. Le taux de récidive de l'insuffisance cardiaque aiguë à un mois a été de 21,7% (n=39 patients), et celui de la mortalité à 3 mois a été de 13,3%.Conclusion: l'ICA vue au niveau des urgences est essentiellement sous forme hypertensive. Le traitement est basé essentiellement sur la CPAP, les vasodilatateurs et les diurétiques. Le taux de récidive était important, et la mortalité était aussi élevée.

Introduction: Young individuals constitute a key population for the screening of problematic use of substances (PUS), but they are not likely to seek support and are hard to reach. Targeted screening programs should thus be developed in the places of care they may attend for other reasons, including emergency departments (EDs). We aimed to explore the factors associated with PUS in young people attending an ED; we measured the subsequent access to addiction care after ED screening., Methods: This was a prospective interventional single-arm study which included any individual aged between 16 and 25 years who attended the main ED of Lyon, France. Baseline data were sociodemographic characteristics, PUS status using self-report questionnaires and biological measures, level of psychological health, and history of physical/sexual abuse. Quick medical feedback was provided to the individuals presenting a PUS; they were advised to consult an addiction unit, and contacted by phone at three months to ask whether they had sought treatment. Baseline data were used to compare PUS and non-PUS groups using multivariable logistic regressions, to provide adjusted odds ratios (aORs) and 95% confidence intervals (95% CI), with age, sex, employment status, and family environment as the adjustment variables. The characteristics of PUS subjects who subsequently sought treatment were also assessed using bivariable analyses., Results: In total, 460 participants were included; 320 of whom (69.6%) were presenting current substance use, and 221 (48.0%) with PUS. Compared to non-PUS individuals, PUS ones were more likely to be males (aOR=2.06; 95% CI [1.39-3.07], P<0.001), to be older (per one-year increase: aOR=1.09; 95% CI [1.01-1.17], P<0.05), to have an impaired mental health status (aOR=0.87; 95% CI [0.81-0.94], P<0.001), and to have a history of sexual abuse (aOR=3.33; 95% CI [2.03-5.47], P<0.0001). Only 132 (59.7%) subjects with PUS could be reached by phone at 3 months, among whom only 15 (11.4%) reported having sought treatment. Factors associated with treatment seeking were social isolation (46.7% vs. 19.7%; P=0.019), previous consultation for psychological disorders (93.3% vs. 68.4%; P=0.044), lower mental health score (2.8±1.6 vs. 5.1±2.6; P<0.001), and post-ED hospitalization in a psychiatric unit (73.3% vs. 19.7%; P<0.0001)., Discussion/conclusion: EDs are relevant places to screen PUS in youth, but the level of seeking further treatment needs to be substantially improved. Offering systematic screening during an emergency room visit could allow for more appropriate identification and management of youth with PUS., (Copyright © 2023 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Primary thoracic cancers affect a large number of patients, mainly those with lung cancer and to a lesser extent those with pleural mesothelioma and thymic tumours. Given their frequency and associated comorbidities, in patients whose mean age is high, these diseases are associated with multiple complications. This article, the last of a series dedicated to emergencies in onco-haematological patients, aims to present a clinical picture of the severe complications (side effects, immune-related adverse events) associated with systemic treatments, excluding infections and respiratory emergencies, with which general practitioners and specialists can be confronted. New toxicities are to be expected with the implementation of innovative therapeutic approaches, such as CAR-T cells, along with immunomodulators and antibody-drug conjugates., (Copyright © 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: To describe the epidemiological, clinical and therapeutic aspects of acute surgical abdomens at the Koutiala Reference Health Center. Patients and method: This was a prospective and descriptive study from August 1, 2017 to May 31, 2018. It included all patients operated on for acute abdomen in the General Surgery Department of the Koutiala Reference Health Center. The study did not include the nonoperated surgical acute abdomens, the non-surgical acute abdomens. Clavien-Dindo classification was used to evaluate complications. Results: One hundred patients were registered. Acute surgical abdomens accounted for 8.4% of consultations (n = 1190), 27.7% of surgical procedures (n = 361) and 70% of surgical emergencies (n = 142). The average age was 34.4 years ± 18.5. Men were in the majority with 70%. The mean duration of change in symptomatology was 4.8 days ± 5.4. Patients consulted for abdominal pain (100%), fever (60%), vomiting (88%) and discontinuation of materials and gases (32%). The physical examination noted abdominal distension (53%), abdominal contracture (36%), abdominal defense (56%) and pain in the cul de sac of Douglas (95%). X-rays of the abdomen without preparation and abdominopelvic ultrasonography contributed to the diagnosis in 46% of cases and 18% of cases, respectively. Acute appendicitis (35%) was the most common etiology followed by acute peritonitis (31%) and acute intestinal obstruction (15%). We performed an appendectomy in 45 patients (45%), resection anastomosis (15%) and excision-suture (13%). The average duration of hospitalization was 4.7 days. The morbidity was 12%. According to the Clavien-Dindo classification, 9 patients were grade III and 3 grade V. The mortality was 3%. Conclusion: Acute surgical abdomens are the most common emergencies in our practice. The diagnosis is clinical and para-clinical most often. Morbidity and mortality remain elevated. The outcome of treatment depends on early management and mastery of abdominal surgery techniques. [ABSTRACT FROM AUTHOR]

Le recueil du consentement de la personne aux soins qui lui sont proposés est un principe quasi-absolu. Ce recueil s'impose également aux secouristes intervenant comme primo-intervenants en amont de la chaîne de santé stricto sensu ; d'autant plus que, du fait de la régulation médicale par le SAMU, cette intervention s'assimile à un acte de soins. Le principe du consentement aux soins s'impose donc à la fois dans un but d'humanisme et dans celui de prévenir tout éventuel contentieux. Pour autant, il existe de nombreuses situations où la gestion du consentement de la personne secourue pourra poser des difficultés pour les secours non médicalisés. Il convient alors d'analyser comment les systèmes de secours peuvent gérer et limiter le risque face aux différentes situations de refus de prise en charge, afin de respecter la dignité des personnes, mais ne pas non plus commettre un abandon de soins. Un travail de concert entre secouristes et médecin régulateur est alors indispensable, surtout à défaut de consentement. Il permettra de déceler les hypothèses où la lucidité est altérée et de mettre en œuvre proportionnellement les mesures utiles. Il permettra également de délivrer une information efficace au patient, corollaire de la question du consentement, et de sensibiliser ce dernier sur les conséquences de sa décision, en veillant qu'elle ait été exprimée en parfaite connaissance de cause. Il semblerait alors utile que les référentiels et recommandations portant sur le secours d'urgence à personne, émanant de la Direction générale de la sécurité civile et gestion de crise, détaillent plus ces situations difficiles afin que les secouristes puissent les anticiper plus efficacement. Enfin, nous proposons un formalisme qui pourrait être envisagé et mis en place dans les cas de refus de prise en charge chez une personne lucide, et nous présentons les intérêts d'une telle mise en place. The acquirement of a person's consent to the medical care that is proposed to a patient is an absolute basic principle in rescue health care. This is mandatory for first arrival rescuers ; especially since their actions are, in view of the French Emergency Medical Service call centers, considered as being a medical act. The basic principle of consent to first medical care hence imposes itself as a humanitarian act as well as preventing any potential litigation. Nevertheless there are numerous situations where the management of the consent of the person in need of non-medical assistance will present difficulties. It is the necessary to analyze how the rescue health care system can manage and limit the risks s linked to the different situations when treatment is refused by the person in need of such help ; and this so as to respect the individual's dignity whilst not abandoning the needed health care. A collaboration between rescue personnel and the call center coordinating medical doctor is then mandatory especially when no consent is obtained. This will enable the detection of hypotheses where the individual's lucidity is altered and implement proportionately required and helpful measures. It will also equally enable the transmission of efficient information to the patient, in relation to the matter of patient consent and to ensure that the patient is aware of the consequence of his or her decision and that this decision was fully expressed. It would hence be deemed useful that the referenced work frame and recommendations, pertaining to the emergency rescue of a person, established by the General Management of Public Safety and Crisis Management detail more in detail these difficult and delicate situations so as to ensure that rescue personnel can better anticipate them. To conclude were commend a formalization of procedures that could be implemented in situations where a patient that has full mental capacities refuses the proposed health care, and we give the advantages of such a procedure be discussed. [ABSTRACT FROM AUTHOR]

Gardening is a popular leisure activity in Switzerland. Approximately 1 million non-occupational accidents are recorded each year; 600,000 of these occur at home or in pursuit of a hobby, including approx. 16,000 accidents while gardening. The aim of this study is to investigate gardening-related accidents. The data for this study were generated from the database of the management system of Berne University Hospital, Switzerland, and retrospectively analyzed. Patients were enrolled who were at least 16 years old - since younger patients in Switzerland are normally treated in specialised Emergency Departments for Paediatrics. The study was restricted to patients who suffered an accident that resulted in physical impairment while working in their own garden. The data were then analysed based on age, sex, triage category, mechanism, causing object, lesion site, diagnoses, severity of injury (monotraumatic or combined with more than one region or polytrauma), in-patient or out-patient treatment. Gardening-related accidents were mainly suffered by middle aged adults (40-69 years). Men were more often affected than women. At consultation, the injury was mostly monotraumatic and could be treated in an out-patient setting. Patients mainly complained of eye injuries and lacerations. The exposed areas of the eyes, fingers and the head or face were the most affected body regions. Falls and stumbling often led to accidents. Injuries were mainly caused by organic material or by the improper use of gardening tools. The data analysis showed that many injuries could have been avoided by simple preventive measures. [ABSTRACT FROM AUTHOR]

Résumé: Le troisième consensus international pour la définition du sepsis recommande l'usage du score quick sepsis-related organ failure assessment (q-Sofa) comme une façon simple et rapide d'identifier les patients infectés susceptibles de s'aggraver. Contrairement au score de syndrome de réponse inflammatoire systémique (Sris), l'évaluation du q-Sofa est simple et rapide. Elle repose sur des items cliniques que sont : l'état de conscience, l'état respiratoire et l'état hémodynamique. L'objectif de cette étude est de décrire l'intérêt du q-Sofa et du Sris score dans l'évaluation pronostique et la prise en charge des urgences chirurgicales de l'adulte. Matériel et méthode : il s'agit d'une étude prospective observationnelle, descriptive, analytique sur douze mois, réalisée au centre hospitalier régional de Saint-Louis (Sénégal). Elle a intéressé les patients âgés de plus de 16 ans admis pour abdomen aiguë chirurgical non traumatique. Nous avons analysé les critères épidémiologiques, évolutifs, le q-Sofa, le Sris, la mortalité. Résultats : nous avons colligé 118 patients. L'âge moyen était de 35,8 avec des extrêmes allant de 16 à 90 ans. Le q-Sofa était positif chez 19,4 % des patients et le Sris score était positif 52,6 % de nos patients. L'instabilité hémodynamique peropératoire fut objectivée chez 18 % de nos patients. Les urgences abdominales infectieuses représentaient 64,4 % des cas. Un Sris négatif était associé à un q-Sofa négatif dans 97,8 % des cas (p = 0,000004). Le taux de mortalité était de 9,5 % et un q-Sofa positif était associé à une mortalité dans 35 % des cas. Concernant la prédiction de la mortalité, l'aire sous la courbe (AUC) du q-Sofa était de 0,844 (0,692-0,995) avec une sensibilité de 80 % et une spécificité de 86,1 %, et le Sris avait une AUC de 0,717 (0,594-0,839) avec une sensibilité estimée à 100 % et une spécificité de 50 %. Pour la prédiction des complications anesthésiques, L'AUC du q-Sofa était de 0,713 (0,506-0,920) avec une sensibilité de 50 % et une spécificité de 84,2 %. En comparaison, le Sris avait une AUC de 0,738 (0,601-0,875) avec une sensibilité de 90 % et une spécificité de 48,6 %. Conclusion : le q-Sofa est plus spécifique que le Sris score dans la prédiction de la mortalité et des complications anesthésiques au cours de la prise en charge des urgences chirurgicales de abdominales de l'adulte. Son utilisation dans les services d'urgences, où les délais pour le diagnostic du sepsis sont importants, doit être encouragée. [ABSTRACT FROM AUTHOR]

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Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)