[Emergency medicine: what's new in 2023]. / Médecine d'urgence: ce qui a changé en 2023.

Research in prehospital and in-hospital emergency medicine is essential to the development of this discipline. By calling certain practices into question (thrombolysis for minor strokes, use of coagulation factors for patients with severe polytrauma), providing access to new technologies (video-laryngoscopy, POCT troponins in pre-hospital care) or questioning new practices (double defibrillation, pulmonary US in pneumonia), research enables emergency physicians to adapt their day-to-day practice.

La recherche en médecine d'urgence, tant sur le plan préhospitalier qu'hospitalier, est nécessaire et même indispensable à la fois au développement de cette discipline, mais également à la reconnaissance de ses spécificités. Par la remise en question de certaines pratiques (thrombolyse pour les AVC mineurs, utilisation de facteurs de la coagulation pour le polytraumatisé sévère), l'accès à de nouvelles technologies (vidéo-laryngoscopie, troponines POCT en préhospitalier) ou le questionnement sur de nouvelles pratiques (double défibrillation, US pulmonaire dans la pneumonie), la recherche permet aux urgentistes d'adapter leur pratique quotidienne à l'état de l'art.

Safety of the pulmonary embolism rule-out criteria rule: Findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry.

BACKGROUND: The diagnostic strategy for pulmonary embolism (PE) includes a D-dimer test when PE probability is low or intermediate, but false-positive D-dimer results are frequent and can result in an unnecessary computed tomography pulmonary angiogram. The PE rule-out criteria (PERC) rule excludes PE without D-dimer testing when pretest probability is <15%. The aim of this study was to assess the safety of the PERC rule strategy in patients included in the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry. METHODS: This retrospective cohort study used data from the RIETE registry, an ongoing, international prospective registry of patients with objectively confirmed venous thromboembolism. The primary outcome was the failure rate of the PERC strategy, represented by the proportion of PERC-negative (PERC-N) patients with a PE included in the registry. Secondary outcomes were a comparison of the clinical characteristics, treatment strategy, and outcome of PERC-N versus PERC-positive (PERC-P) patients at 3 months. RESULTS: From 2001 to 2021, a total of 49,793 patients with acute PE were enrolled in the RIETE registry. We included 48,903 in the final analysis after exclusion of 890 patients with an undetermined PERC status. Only 346 patients were PERC-N with a failure rate of 0.7% (95% confidence interval 0.6%-0.8%). PERC-N patients presented more frequently with chest pain but less often with dyspnea, syncope, or hypotension. They also had subsegmental or segmental PE more frequently, were more often treated with direct oral anticoagulants, and received mechanical or pharmacological thrombolysis less often. In addition, PERC-N patients had a lower incidence of recurrent deep vein thrombosis, major bleeding, and death attributed to PE during the 3-month follow-up. CONCLUSIONS: A low failure rate of the PERC rule was observed in the RIETE registry, thus supporting its use to safely identify patients with an unlikely probability of PE.

Perceptually Regulated Exercise Test Allows Determination of V˙O2max and Ventilatory Threshold But Not Respiratory Compensation Point In Trained Runners.

This study aimed to investigate the differences in maximal oxygen uptake (V̇O2max) and submaximal thresholds between a standard graded exercise test (GXT) and a perceptually regulated graded exercise test (PRGXT) in trained runners. Eleven well-trained middle- to long-distance runners performed both tests in a randomized order. PRGXT used incremental "clamps" of rating of perceived exertion (RPE) over 10×1-min stages on an automated treadmill equipped with a sonar sensor allowing them to change their running speed instantly and in a natural way. GXT used fixed 1 km.h-1 increment every minute. Ventilatory threshold (VT) and respiratory compensation point (RCP) were determined using ventilatory equivalents. No differences were found in V̇O2max (68.0 (5.3) vs. 69.5 (5.9) ml·min-1·kg-1, p=0.243), minute ventilation (V̇E) (159.4 (35.0) vs. 162.4 (33.7) l·min-1, p=0.175), heart rate (HR) (188.4 (6.9) vs. 190.7 (5.2) bpm, p=0.254) and speed (21.0 (1.7) vs. 21.1 (2.3) km·h-1, p=0.761) between GXT and PRGXT. At VT, there were no significant differences between GXT and PRGXT for any outcome variables. For 8 of 11 subjects, it was not possible to determine RCP from ventilatory equivalent in PRGXT. GXT appears more relevant for a comprehensive gas analysis in trained runners.