[Updates in emergency medicine]. / Médecine d'urgence.

In 2021, emergency medicine has been impacted by the Covid19 pandemic. The repercussions were both on clinical and scientific aspects specific to our discipline. For this special issue, we have chosen not to insist on the pandemic but to return to some fundamentals of our discipline: cardiovascular emergencies remain the leading cause of death in the world and the aspects of risk stratification of pathologies such as acute coronary syndromes or neurovascular attack remain a daily issue within the framework of the strategies of management and investigation in emergency medicine. In addition, the consideration of alternative treatments in the context of pathologies, ranging from cannabis consumption to cardiac arrest and atrial fibrillation, also remains a daily challenge.

En 2021, la médecine d'urgence a été impactée par la pandémie Covid19. Les répercussions ont autant été cliniques que sur la recherche scientifique spécifique à notre discipline. Pour ce numéro spécial, nous avons fait le choix de ne pas insister sur la pandémie, mais de revenir à certains fondamentaux de notre discipline : l'urgence cardiovasculaire reste la première cause de mortalité dans le monde. Les aspects de stratification du risque pour ces pathologies, telles que les syndromes coronariens aigus ou les AVC, sont toujours un enjeu quotidien dans le cadre des stratégies de prise en charge et d'investigation en urgence. Par ailleurs, la prise en compte d'alternatives thérapeutiques dans des pathologies très variées, allant de la consommation de cannabis à l'arrêt cardiaque en passant par la fibrillation auriculaire, reste également un enjeu au quotidien.

[Asthmatic exacerbation in pregnant woman]. / Exacerbation asthmatique chez la femme enceinte.

The physiological changes in the pregnant woman expose her to a risk of faster respiratory decompensation. Asthma affects 2-13% of pregnancies. It is therefore important to ensure regular monitoring to allow good control of asthma to reduce the risk of exacerbations. Finally, the background treatment, such as exacerbations, must be identical to the treatment of other patients.

Les modifications physiologiques chez la femme enceinte l'exposent à un risque de décompensation respiratoire plus rapide. L'asthme concerne 2-13% des grossesses. Il est donc important d'assurer un suivi régulier pour permettre un bon contrôle de l'asthme afin de diminuer le risque d'exacerbations. Enfin, le traitement de fond, comme celui des exacerbations, doivent être identiques aux traitements des autres patients.

A confirmed bite by a Beautiful Pit Viper (Trimeresurus venustus) resulting in local symptoms.

This case report describes the effect of an envenomation by the Beautiful Pit Viper Trimeresurus venustus (or Cryptelytrops venustus), which is a green pit viper native to Thailand and Malaysia. A previously healthy 60-year-old snake breeder with no relevant medical history was bitten by his adult T. venustus in the third finger of his right hand while taking it out of the feeding box. The bite was painful and swelling progressed to include his whole hand within an hour after the bite. He was treated symptomatically with pre-emptive antibiotics and analgesics, never developed any hematological disorders such as coagulopathy and bleeding or disseminated intravascular coagulation and was discharged 26 hours after the bite. The clinical course in our patient matched two other well-documented cases reported to our Poisons Centre, and one further case presented as a conference-poster. All patients recovered with symptomatic therapy and never required antivenom. Therefore, bites by T. venustus seem to present with less severe symptoms compared to other Trimeresurus species.