[Out-of-hospital equipment of emergency medical services for hemorrhagic shock management: can do better!]. / Équipement des Smur pour la prise en charge préhospitalière du choc hémorragique : peut mieux faire !

INTRODUCTION: Hemorrhagic shock is an emergency, which may benefit from a medicalized prehospital care. Our goal was to survey the means available in the 370 French prehospital medicalized emergency services (SMUR) for hemorrhagic situations. METHODS: Multicenter descriptive observational study by email then phone with all the 370 French SMUR leaders. The questionnaire was created by investigators of the project through a Delphi method, and was about service protocols concerning hemorrhagic patient care, hemorrhagic parameters measure equipment available, intravenous solutes and drugs as well as various medical devices useful or perceived to be useful to support prehospital hemorrhagic shock. The results are expressed in numbers and percentages. RESULTS: The overall response rate was 48% (n=178). Protocols were established in between 43% (n=76) and 47% (n=83) according to etiology, measuring devices were available in 5% (n=9) of the Smur for hemostasis up to 89% (n=158) for hemoglobin measurement. Available intravenous solutes were mainly isotonic salty serum (95%, n=169), hydroxylethylstarch (83%, n=148) and Ringer lactate (73%, n=130). Tranexamic acid was available in 84 (47%) Smur. The teams had access to erythrocytes concentrates, fresh frozen plasma and platelets in 84% (n=150), 44% (n=79) and 23% (n=41) respectively. Eighty-one (46%) Smur had tourniquets and 127 (71%) anti-shock trousers. Finally, 57 (32%) had a pelvic restraint belt. CONCLUSION: There is a great disparity in the means available in the French Smur for the support of prehospitalization bleeding. The majority the Smur physicians can transfuse in a prehospital setting. On the other hand, a minority of teams can actively warm patients, employ tranexamic acid or use pelvic restraint belts.

Adverse drug reactions in an emergency medical dispatching centre.

PURPOSE: The purpose of this study is to assess the incidence of adverse drug reactions (ADR) leading to call an emergency medical dispatching centre. METHODS: A prospective, observational, monocentric clinical study performed over a 2-year period (2011-2012) in a French prehospital emergency dispatching centre, the Service d'Aide Médicale Urgente (SAMU) covering 1,156,000 inhabitants. All adult patients (age≥18) who called for any cause were included. We created an electronic trigger 'iatrogenic event' implemented by the dispatching physician for each suspected case of ADR, then we completed the analyses of all the cases with a chief complain represented in more than 1% of the triggered cases. The primary outcome variable was the occurrence of any possible ADR. We then used the French method of causal relationship assessment. RESULTS: The SAMU dispatched 339,915 calls during the study. In total, 1,467 ADRs were identified, representing 0.95% (CI 95% 0.90-1.00%) of cases. ADRs were as serious (SADR) in 51.06% (CI 95% 48.45-53.67%) of cases. The major ADR observed was haemorrhage, (42.81% (CI 95% 40.62-45.00%), n=628) followed by allergy, hypoglycaemia, vomiting, dizziness and drowsiness. The class of drugs most frequently involved was antithrombotic (43.69% (CI 95% 41.45-45.93%), n=641), followed by insulin (17.98% (CI 95%:17.06-18.90%), n=264). CONCLUSIONS: Emergency calls concerning ADRs were estimated as 9/1,000, and one out of two is serious.

[State of the art. Publications of French emergency's teams since 5 years]. / Publications des équipes françaises de médecine d'urgence. Où en est-on depuis cinq ans ?

INTRODUCTION: The development of emergency medicine in France and its valuation can take place only through acknowledged scientific publications. The aim of our study was to analyze the publications of French teams in emergency medicine since 2006. MATERIAL AND METHODS: Observational, descriptive study, from January 1st, 2006 to December 31st, 2010 including, thanks to Medline, studies related to emergency medicine with, as keywords, "medicine d'urgences; urgences; emergency; emergency medicine; French; France" the names of heads of the emergency departments, of the urgent medical aid services (samu) and of anaesthetics services in mainland France. Data collection focused on the type of study, subject, place of conducting the study and grade of international quality. RESULTS: Three hundred and twenty-five publications were listed: 39% (n=126) of the studies were carried out in prehospital. We identified 28% of observational studies (n=92), 20% of randomized prospective (n=66), 19% of cohorts (n=62), 18% of case reports (n=59), 10% of clarifications (n=32) and 4% of general reviews (n=11). The most frequent theme was the cardiology (38% of cases). The most favourite journal was the Annales françaises d'anesthésie et de réanimation (Afar) (18%, n=57). CONCLUSION: The release of French studies in emergency medicine is increasing, with an improvement in the quality of the published studies. All these results demonstrate the progress made since five years in emergency medicine in France but also the work that remains to be done in our rising medical specialization.

Migraine: diagnosis and pharmacologic treatment in emergency department.

Acute headache is a common chief complaint in the Emergency Department (ED), accounting for up to 4% of all ED visits. Migraine is a common, chronic, at times incapacitating disorder, characterized by attacks of severe headache, autonomic nervous system dysfunction, and in some patients, an aura characterized by various neurologic symptoms. It is the most common cause of severe, recurring headaches. Although most headaches in the ED are benign, one should be vigilant in searching for "red flags", which may represent dangerous conditions. In addition to properly identifying important secondary causes of headache, the goal of acute therapy is to provide rapid, complete, and sustained relief of pain and associated symptoms without generating significant adverse effects. In many patients, migraine responds well to simple treatment at the time of an attack. In patients with substantial disability, it is appropriate to prescribe a triptan early in the course of treatment, in keeping with a stratified approach to care.

[Physician staffed ambulances are better for patients' analgesia on arrival at the emergency department]. / Le Smur meilleur vecteur pour une analgésie des patients traumatisés à l'arrivée aux urgences.

OBJECTIVES: To find out prehospital factors linked with low pain on arrival into a traumatic emergency unit. METHODS: A 4-month monocentric prospective study, including patients recruited at their arrival into a traumatic emergency unit. Pain (with a numerical rating scale [NRS]), anxiety, prehospital care including the type of transportation (physician staffed ambulances {service mobile d'urgence et de réanimation [Smur]}, emergency medical technicians, or firemen ambulances), immobilization and analgesics used were evaluated. These data were collected on arrival at the hospital by the ED orientation nurse. Uni- and multivariate analysis were performed to identify low pain's predictive factors (e.g. with a NRS ≤3). RESULTS: Three hundred and four patients were recruited, mean age=51±25, sex ratio=1.8, mean pain/10=5.8±2.9, 64% with a moderate or severe pain on arrival (NRS>3). For one third of patients, immobilizations hadn't been performed during the prehospital phase. Medical management by Smur is a low pain predictive factor (OR=5.8; CI 95%=1.4-24.16), anxiety is a pejorative factor (OR=0.53 CI 95%=0.38-0.75). CONCLUSION: Our study highlights the physician staffed ambulances' effectiveness in prehospital trauma victims' management and raises the question of anxiolysis as an adjuvant for traumatic pain management.

[Interscalene brachial plexus block for glenohumeral luxation in prehospital medicine]. / Bloc interscalénique pour luxation glénohumérale en médecine préhospitalière.

We report the case of a successful interscalene block for the pain management of a glenohumeral luxation in prehospital care. Interscalene block is an attractive technique in prehospital pain management. However, this regional anaesthesia technique must be performed only by a skilled anaesthesiologist.

[Prehospital cricothyrotomy: a case report]. / Cricothyrotomie préhospitalière: à propos d'un cas.

Case report of a patient with tonsillitis treated with anti-inflammatory. The patient presented a dyspnoea and finally a cardiac arrest. The oral intubation was impossible and cricothyrotomy had to be performed with a catheter over needle technique. We found a total airway obstruction due to an epiglottis abscess. The patient died few days later of sepsis. We recommend having wire-guided cricothyrotomy technique or catheter-over-needle technique in all prehospital emergency unit and having emergency physician trained to the cricothyrotomy technique.