RESUMO
Visits to the emergency department are often a difficult time for LGBTQIA+ people, mainly because of the frequent discrimination in healthcare environments and the lack of knowledge of medical and nursing staff. This article begins by presenting some epidemiological features, before discussing specific issues such as contraception and fertility, hormone therapy, sexually transmitted infections, surgical complications, psychiatric pathologies, and traumatology, from the perspective of the emergency physician. Finally, suggestions for further reflection and improvement are proposed.
Les visites aux urgences représentent souvent des moments difficiles pour les personnes LGBTQIA+, principalement en raison des discriminations particulièrement fréquentes dans les milieux de soins et du manque de connaissances du personnel médico-soignant. Cet article présente dans un premier temps quelques chiffres épidémiologiques, avant de discuter des enjeux spécifiques, comme la contraception et la fertilité, l'hormonothérapie, les infections sexuellement transmissibles, les complications opératoires, les pathologies psychiatriques ou la traumatologie, le tout sous le prisme de l'urgentiste. Enfin, des pistes de réflexion et d'amélioration sont proposées.
Assuntos
Serviço Hospitalar de Emergência , Traumatologia , Humanos , Anticoncepção , Fertilidade , ConhecimentoRESUMO
Teamwork is essential in emergency medicine, but in practice it can be polluted by communication difficulties, a lack of understanding of everyone's roles and responsibilities, and a discordant definition of operating methods and objectives. Today, there is a strong awareness of the need to train medical and healthcare teams in interprofessional collaborative practice to learn how to work as a team, reduce medical errors and improve patient safety. Simulation is a recognized and effective pedagogical modality for achieving these objectives. It is now permanently established in pre- and postgraduate medical-nursing training courses in emergency medicine.
Le travail en équipe est indispensable en médecine d'urgence mais, dans la pratique, il peut être pollué par des difficultés de communication, une méconnaissance des rôles et responsabilités de chacun, et une définition discordante des modes de fonctionnement et des objectifs. Aujourd'hui, il y a une forte prise de conscience de la nécessité de former les équipes médicosoignantes à la pratique collaborative interprofessionnelle pour apprendre à travailler en équipe, réduire les erreurs médicales et améliorer la sécurité des patient-e-s. La simulation est une modalité pédagogique reconnue et efficace pour atteindre ces objectifs. Elle est désormais implantée de façon pérenne dans les cursus de formation médico-soignante pré et postgraduée en médecine d'urgence.
Assuntos
Medicina de Emergência , Relações Interprofissionais , Comunicação , Humanos , Equipe de Assistência ao Paciente , Segurança do PacienteRESUMO
To improve survival rates during CPR, some patients are put on extracorporeal membrane oxygenation (ECMO). Among children who have undergone ECMO cardiopulmonary resuscitation (ECPR), the overall rate of survival to discharge is close to 40%. However, despite its wide acceptance and use, the appropriate indications and organizational requirements for ECPR have yet to be defined. Our objective was to assess the clinical outcomes of children after ECPR and to determine pre-ECPR prognostic factors for survival to guide its indication. Among the 19 patients who underwent ECPR between 2008 and 2014 in our center, 16 patients (84%, 95% confidence interval: 62-95%) died during their hospital stay, including nine (47%) who were on ECMO and seven (37%) after successful weaning from ECMO. All three survivors had normal cognitive status, but one child suffered from spastic quadriplegia. Survivors tended to have lower lactate, higher bicarbonate, and higher pH levels before ECMO initiation, as well as shorter length of resuscitation. In conclusion, in our center, ECPR has a poorer outcome than expected. Therefore, it might be important to identify, a priori, patients who might benefit from this treatment.
