Physician wellbeing and burnout in emergency medicine in Switzerland.

Emergency physicians are the most at-risk medical specialist group for burnout. Given its consequences for patient care and physician health and its resulting increased attrition rates, ensuring the wellbeing of emergency physicians is vital for preserving the integrity of the safety net for the healthcare system that is emergency medicine. In an effort to understand the current state of practicing physicians, this study reviews the results of the first national e-survey on physician wellbeing and burnout in emergency medicine in Switzerland. Addressed to all emergency physicians between March and April 2023, it received 611 complete responses. More than half of respondents met at least one criterion for burnout according to the Maslach Burnout Inventory - Human Services Survey (59.2%) and the Copenhagen Burnout Inventory (54.1%). In addition, more than half reported symptoms suggestive of mild to severe depression, with close to 20% screening positively for moderate to severe depression, nearly 4 times the incidence in the general population, according to the Patient Health Questionnaire-9. We found that 10.8% of respondents reported having considered suicide at some point in their career, with nearly half having considered this in the previous 12 months. The resulting high attrition rates (40.6% of respondents had considered leaving emergency medicine because of their working conditions) call into question the sustainability of the system. Coinciding with trends observed in other international studies on burnout in emergency medicine, this study reinforces the fact that certain factors associated with wellbeing are intrinsic to emergency medicine working conditions.

[Ketamine for medically-delegated analgesia in the Emergency Department]. / Kétamine pour l'antalgie médico-déléguée aux urgences.

Ketamine has the optimal characteristics for use in an Emergency Department. Added in 2020 to the Emergency Department's medically delegated analgesia protocol of the Cantonal Hospital of Neuchâtel (RHNe), it has become a valuable ally for the management of acute pain. The purpose of this article is to present the advantages of its use in an Emergency Department by means of a review of evidence and experience.

La kétamine, employée comme analgésique, possède les caractéristiques optimales pour une utilisation au sein d'un service d'urgences. Ajoutée en 2020 au protocole d'antalgie médico-déléguée des Urgences du Réseau hospitalier neuchâtelois (RHNe), son adoption par l'équipe en fait désormais un précieux allié pour la prise en charge de la douleur aiguë. Cet article a pour but de présenter les avantages liés à son utilisation au sein d'un département d'urgences par un retour d'expérience et une revue de la littérature d'évidence et d'expérience.

Cannabinoid hyperemesis syndrome and cannabis withdrawal syndrome: a review of the management of cannabis-related syndrome in the emergency department.

BACKGROUND: Cannabis-related medical consultations are increasing worldwide, a non-negligible public health issue; patients presenting to acute care traditionally complain of abdominal pain and vomiting. Often recurrent, these frequent consultations add to the congestion of already chronically saturated emergency department(s) (ED). In order to curb this phenomenon, a specific approach for these patients is key, to enable appropriate treatment and long-term follow-up. OBJECTIVES: This study reviews cannabinoid hyperemesis syndrome (CHS) and cannabis withdrawal syndrome (CWS), in a bid to help promote better understanding and handling of pathologies associated with chronic cannabis use. Following a literature review, we present a novel therapeutic algorithm aimed at guiding clinicians, in a bid to improve long-term outcomes and prevent recurrences. METHODS: Using the keywords "Cannabis," "Hyperemesis," "Syndrome," "Withdrawal," and "Emergency Medicine," we completed a literature review of three different electronic databases (PubMed®, Google scholar®, and Cochrane®), up to November 2021. RESULTS: Although often presenting with similar symptoms such as abdominal pain and vomiting, cannabinoid hyperemesis syndrome (CHS) and cannabis withdrawal syndrome (CWS) are the result of two differing pathophysiological processes. Distinguishing between these two syndromes is essential to provide appropriate symptomatic options. CONCLUSION: The correct identification of the underlying cannabis-related syndrome, and subsequent therapeutic choice, may help decrease ED presentations. Our study emphasizes the importance of both acute care and long-term outpatient follow-up, as key processes in cannabis-related disorder treatment.

Death in the Emergency Department: A Retrospective Analysis of Mortality in a Swiss University Hospital.

Acute treatment in emergency medicine revolves around the management and stabilization of sick patients, followed by a transfer to the relevant medical specialist, be it outpatient or inpatient. However, when patients are too sick to be stabilized, i.e., when the care provided in the Emergency Department (ED) may not be sufficient to enable transfer, death may occur. This aspect of emergency medicine is often overlooked, and very few public data exist regarding who dies in the ED. The following retrospective analysis of the mortality figures of a Swiss university hospital from January 1st 2013 to December 31st 2016 attests to the fact that with an incidence of 2.6/1,000, death does occur in the ED. With a broad range of aetiologies, clinical severity at presentation has a high correlation with mortality, a finding that reinforces the necessity of good triage system. Our analysis goes on to show that however (in)frequent death in the ED may be, there exists a lack of advanced directives in a majority of patients (present in only 14.8% of patients during the time of study), a worrying and often challenging situation for Emergency Medicine (EM) teams faced with premorbid patients. Furthermore, a lack of such directives may hinder access to palliative care, as witnessed in part by the fact that palliative measures were only started in 16.6% of patients during the study. The authors hope this study will serve as a stepping stone to promote further research and discussion into early identification methods for patients at risk of death in the ED, as well as motivate a discussion into the integration of palliative care within the ED and EM training curriculum.

Diffuse Subcutaneous Emphysema and Pneumomediastinum Secondary to a Minor Blunt Chest Trauma.

Full medical evaluation is paramount for all trauma patients. Minor traumas are often overlooked, as they are thought to bear low injury potential. In this case report, we describe the case of a 48-year-old man presenting to our Emergency Department with mild to moderate right-sided shoulder and scapular pain following a fall from his own height ten days previously. Clinical and paraclinical investigations (CT) revealed diffuse right shoulder pain, with crepitations on palpation of the neck, right shoulder, and right lateral chest wall. Computed tomography (CT) demonstrated right-sided costal fractures (ribs 7 to 9), with diffuse subcutaneous emphysema and pneumomediastinum due to laceration of the visceral and parietal pleura and the adjacent lung parenchyma. In addition, a small ipsilateral pneumothorax was found. Surprisingly, the clinical status was only minimally affected by mild to moderate pain and minor functional impairment.

Best approaches in the battle against Globesity? Learning lessons from our experience tackling HIV-AIDS and tobacco smoking.

In 2008, two-thirds of the annual global death toll was attributable to non-communicable diseases (NCDs). Defined as chronic conditions often caused or exacerbated by non-obligated lifestyle behaviours, the NCD epidemic has been fuelled by a combination of risk factors, including tobacco use, an unhealthy diet combined with lack of physical activity and overweight-obesity, and harmful alcohol use. The health consequences are mainly seen as cardiovascular diseases, diabetes, cancers and chronic respiratory problems. Generally associated with the West, they are now recognized as a global threat to public health. They are also an unsupportable global health economic burden. NCDs incidence can be significantly reduced through the adoption of proven and affordable interventional measures which are complementary to global health efforts already underway. To head off the certain future surge in morbidity and mortality, at record costs to health budgets worldwide, there is a pressing need to change global population's behaviours and choices in relation to these risk factors. The most pressing challenge in NCD prevention is combating the rise in overweight-obesity, which threatens individuals, communities and countries as never before. If not overcome, this may undo much of the progress seen in reducing the incidence of myocardial infarctions, strokes and some cancers evident from the 1960s onwards.

Dyslipidemia, statins, and CKD patients' outcomes - review of the evidence in the post-sharp era.

Hyperlipidemia in the general population is strongly associated with an increased incidence of major adverse cardiovascular (CV) events (MACE). It is well established that HMG-CoA reductase inhibitors (statins) reduce CV and all-cause mortality in the general population, as well as in patients with CV disease (CVD). However, such a finding has not been definitively confirmed in patients with chronic kidney disease (CKD). Given that CV risk gradually increases with increasing stages of CKD (and is even higher in dialysis patients), it is of major relevance and importance to identify whether CKD patients might also benefit from alteration of lipid fractions, and how this might best be achieved. Bearing in mind that animal model and preclinical evidence suggests dyslipidemia might also be a factor promoting worsening renal function, it could legitimately be asked whether treating it may also therefore have a nephroprotective effect.