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Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Patients with electrical injury are considered to be at risk of cardiac arrhythmia. Assessing the risk of developing a major adverse cardiac event (MACE) is the cornerstone of patient management. The aim of this study was to assess the performance of initial troponin and troponin rise to predict Major Adverse Cardiac Events (MACEs) in all patients with electrical injuries admitted to the Emergency Department. Methods This is a multicentre retrospective study in which consecutive patients with electrical injuries admitted to the Emergency Departments (ED) (adult and paediatric) of five French Hospitals were included between 2005 and 2019. The threshold for troponin elevation is based on the European Society of Cardiology guidelines for patients presenting without persistent ST segment elevation. The primary endpoint was the rate of MACE. Results A total of 785 included patients were admitted to ED with a first diagnosis of electrical injury during the study period. Troponin assays were performed in 533 patients (67.9%), including 465 of 663 adults (70.1%) and 68 of 122 children (55.7%) and 17/533 (3.2%) of patients had an initial elevated troponin. If none of the clinical criteria for MACE were present (i.e., previous known heart disease, exposure to a high voltage of ≥ 1000 Volts, initial loss of consciousness, or an abnormal initial ECG), this defined a low-risk subgroup (n = 573, 76.0%) that could be safely discharged. The initial positive troponin assay had a sensitivity of 83.3 (95% CI 35.9–99.6%), a specificity of 97.7 (95% CI 96.1–98.8%), a positive likelihood ratio 36.6 (95% CI 18.8–71.1%) and a negative predictive value of 99.9 (95% CI 99.2–99.9%) in predicting a MACE. Conclusions Troponin assay appears to be a predictive marker of MACE risk and should be considered in high-risk patients.

Abstract: Objectives: Describe the epidemiology and the survival of patients with traumatic cardiac arrest (CA), and compare them to those with nontraumatic CA. Highlight the weaknesses in their care and consider ways to improve their survival. Method: Traumatic and nontraumatic CA are described using the Utstein style in the “réseau nord-alpin des urgences” registry. Regarding the traumatic CA, we focus on circumstances, types of injuries and specific resuscitation techniques used. Results: From 1st January 2004 to 31st December 2005, prehospital medical teams provided care to 1552 victims of CA, 129 of whom were trauma patients (8.3%). Average age was 47.1 years; 74.4% were males. Blunt trauma occurred in 94.6%. None of the patients had chest tube insertion or thoracotomy on the scene. A return of spontaneous circulation was observed in 24.8%, the survival after 24h was of 3.9%, and 0.8% of patients remained alive 1 year following the accident. The topography of lesions responsible for the CA as well as the fact that these lesions are limited or multiorgan influence the survival. Conclusion: The survival of patients with prehospital traumatic CA is catastrophic and it is worse than that of patients with nontraumatic CA. However, a specific earlier and more adapted prehospital resuscitation could help improve this survival. [Copyright &y& Elsevier]

Abstract: We report a case of fatal outcome poisoning by massive exposure to hydrogen sulfide of a sewer worker. This rare event was associated with a moderate intoxication of two members of the rescue team. The death was due to asystole and massive lung oedema. Autopsy analysis showed diffuse necrotic lesions in lungs. Hydrogen sulfide is a direct and systemic poison, produced by organic matter decomposition. The direct toxicity mechanism is still unclear. The systemic toxicity is due to an acute toxicity by oxygen depletion at cellular level. It is highly diffusable and potentially very dangerous. At low concentration, rotten egg smell must trigger hydrogen sulfide suspicion since at higher concentration it is undetectable, making intoxication possible. In case of acute intoxication, there is an almost instantaneous cardiovascular failure and a rapid death. Hydrogen sulfide exposure requires prevention measures and more specifically the use of respiratory equipment for members of the rescue team. [Copyright &y& Elsevier]

Introduction La résistance bactérienne aux antibiotiques est un problème de santé publique. L’infection est un motif de consultation fréquent aux urgences. L’objectif de cette étude est de décrire l’impact d’une formation ciblée infectiologique auprès des urgentistes sur la qualité de prescription des antibiotiques. Matériels et méthodes Nous avons réalisé une étude rétrospective, unicentrique, comparative de la pertinence et de la conformité des prescriptions d’antibiotiques aux urgences sur deux périodes : avant et après formation des urgentistes entre 2014 et 2016. Une première analyse de 300 dossiers en 2014 montrait 46 % d’erreurs de prescription antibiotique, essentiellement pour des infections urinaires, cutanées, respiratoires. En 2015, nous avons proposé aux urgentistes une formation antibiotique ciblée sur ces pathologies infectieuses fréquemment rencontrées. La pertinence et la conformité des prescriptions (molécule, dose, durée, voie) ont été les critères de jugement avant et après intervention. Évaluation par un infectiologue et un urgentiste en aveugle, avec arbitrage par un 2 e infectiologue en cas de désaccord. L’évaluation s’appuyait sur les référentiels locaux (ANTIBIOGARDE ® ) ou nationaux. Une comparaison avant/après a été faite par test de fisher. Résultats Six cents prescriptions antibiotiques (300 en hiver et 300 en été) ont été analysées avant et après l’intervention. Les prescriptions antibiotiques pertinentes et conformes sont plus nombreuses de façon significative après intervention, en 2016 (413/600 situations soit 68,8 % des prescriptions) qu’en 2014 (334/600 situations évaluées soit 55,7 % des prescriptions, p < 0,001). Il n’y a pas de différence significative ( p = 0,07) dans la pertinence des prescriptions d’antibiotiques, jugée justifiée dans 89,5 % des cas avant et après intervention. La molécule prescrite est plus adaptée de façon significative en 2016 (474/600 cas 87,9 %) qu’en 2014 (438/600 cas 81,7 %), aussi bien en hiver qu’en été ( p = 0,001). Moins d’erreur de prescription de posologie (critère incluant la durée de traitement) ont été faites : 12 % en 2016, contre 20,7 % en 2014 ( p < 0,001). Ceci aussi bien en été qu’en hiver. La voie utilisée est également plus appropriée de façon significative ( p = 0,005) en 2016, 99,2 % cas contre 96,6 % en 2014. Conclusion Cette étude permet de mieux connaître les habitudes de prescriptions antibiotiques des médecins urgentistes. Une formation ciblée sur les pathologies infectieuses les plus souvent rencontrées, peut permettre d’améliorer les bonnes pratiques de prescriptions antibiotiques. Une évaluation régulière des prescriptions serait intéressante afin de voir l’impact de l’intervention sur le long terme. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate the rate of pre-cancerous and cancerous endometrial lesions in hysterectomy during vaginal reconstructive pelvic surgery. Patients and methods: In this retrospective and continuous study, a vaginal procedure including reconstructive pelvic surgery with vaginal mesh, hysterectomy and adnexectomy was performed in 152 patients between April 2001 and January 2006. An ultrasonography evaluation was done before surgery. A histopathological analysis of uterus, ovaries and tubes was also performed. Results: In the analysis of 136 cases, precancerous and cancerous lesions have been diagnosed while ultrasonography or cervical smear were normal: 2 (1.4%) endocervical dysplasia, 1 (0.7%) cervical epidermoid carcinoma, 10 (7.35%) endometrial complex non-atypical hyperplasia, 7 (5.1%) endometrial atypical hyperplasia and 2 (1.4%) endometrioid endometrial carcinoma. There was not any cancerous lesions in tubes or ovaries. At 10months, mesh exposure was low at 2.9% (four cases). Discussion and conclusion: The important rate of cancerous and precancerous lesions raise the question of hysterectomy or hysteroscopy and endometrial biopsy in case of uterine preservation during a vaginal reconstructive pelvic surgery. [Copyright &y& Elsevier]

Abstract: Objectives: To reduce the episiotomy rates, according to the Clinical Practice Guidelines, of 2005, from the French College of Obstetricians and Gynaecologists. Patients and methods: A cross sectional study was conducted, in the university hospital maternities (Maternity 1 and 2) with a retrospective record from medical files. Patients who had delivered in those maternities, by vaginal route, after 22 weeks amenorrhea were eligible. The global rate of episiotomy was analysed from 2006 to 2008. A descriptive clinical study was performed with a retrospective analysis (from July to December 2005 on 100 medical files and from July to December 2007 on 85 files). Besides, a study of episiotomy rate was conducted from 2006 to 2008. Improvement actions were developed between the two phases of assessment of the audit: sharing and comparing the results to standardized episiotomy rates, and elaborating an informatized regional perinatality file with episiotomy related items and national recommendations. Results: Episiotomy rate decreased during the study, from 22.35% in 2005 to 19.34% in 2008, in the Ward 1 (p <0.0001) and from 33.62% in 2005 to 17.93% en 2008 (p <0.0001) in the Ward 2. An improvement was observed between the two periods of audits, for each item of the chart but without statistical signification. Discussion and conclusion: Theses procedures have led to a positive impact on practices thanks to the work group and because of the politics of the perinatal network in favour of an episiotomy reduction. We hope these results could be improved in the future. [Copyright &y& Elsevier]

Abstract: Objective: To assess postoperative pain after POP surgery by vaginal approach with and without mesh. Patients and methods: One hundred and thirty-two consecutives patients operated on for POP (POP-Q≥2) were enrolled. Surgical procedure was a traditional repair without mesh in 66 women and a mesh repair (Prolift™) in 66 women. Postoperative pain was prospectively assessed by autoadministred questionnaires including analog visual scale. Pain scores were recorded 1day after surgery (D1), at discharge, at 1month follow-up (M1) and at 3 to 6months follow-up (M3–6). We focused specially on mesh repair, age, previous prolapse procedure, hysterectomy, sacrospinofixation, transobturator sling, pre- and postoperative POP-Q score. Results: At discharge, pain score was significantly higher in the mesh group (1.2±1.8 versus 0.5±0.9, P =0.021). Pain score were low (VAS<3) and similar in the two groups with or without mesh at M1 and M3–6 follow-up. When focusing on associated factors, hysterectomy as a significant higher pain score at day 1, transobturator slings associated to traditional repair are more painful at D1 versus associated to mesh repair, sacrospinofixation has only a statistical tendency (P =0.08) more painful at D1. Discussion and conclusion: Pain score are low after both traditional or mesh repair by vaginal route. Mesh repair, hysterectomy and sacrospinofixation are more painful only in the first days after surgery. Our study supports the theory that transvaginal mesh procedure allows a quick return to normal life. [ABSTRACT FROM AUTHOR]

Background Rapid reperfusion is crucial in the treatment of acute ST-elevation myocardial infarction (STEMI). The latest STEMI guidelines from the European Society of Cardiology (ESC) recommend primary percutaneous coronary intervention (PPCI) if the delay between first medial contact (FMC) and wire passage is ≤ 120 min and fibrinolysis for delays > 120 min. With a ≤ 120 min delay from FMC to wire acceptable for PPCI, it appears that most patients would be eligible for/have access to PPCI. We sought to assess time to reperfusion in STEMI patients in a real-life registry and according to ESC guidelines. Methods RESURCOR is an ongoing registry of all cases of acute STEMI in the north French Alps, an area that covers three French departments (Isere, Savoie, Haute-Savoie), with 1.8 million inhabitants, and a population that doubles during the summer and winter holidays. In RESURCOR, delays and care pathway for STEMI patients, from symptoms onset to reperfusion, were recorded by the physicians. Results Between October 2002 and December 2011, 6169 patients were enrolled in the RESURCOR registry. Of these, 2573 patients were treated with PPCI and had data recorded for delay from FMC to artery puncture; 329 patients had a contraindication to fibrinolysis and 556/2244 (25%) of the PPCI patients without a contraindication to fibrinolysis had a delay from FMC-to-artery puncture > 120 min. A total of 2768 patients were treated with fibrinolysis with recorded delays and 1381/2768 (50%) were admitted to a PCI-capable hospital with a delay from FMC-to-admission (or artery puncture in case of urgent coronary angiogram) < 120 min. Conclusion When the latest ESC STEMI guidelines are applied to a real-world population, it appears that one-quarter of patients treated with PPCI would have been recommended for fibrinolysis and half of those who received fibrinolysis would have been recommended for PPCI. [ABSTRACT FROM AUTHOR]