Further Utilization of Emergency Department and Inpatient Psychiatric Services Among Young Adults Admitted at the Emergency Department With Clinical Alcohol Intoxication.

Objectives: To assess in a cohort of young adults admitted with alcohol intoxication (AI) to the Emergency Department (ED): how many patients are readmitted to the ED or to a Psychiatric Department (PD) inpatient unit; and which characteristics are associated with further ED and PD inpatient admissions.

Methods: In 630 patients aged 18 to 30 years admitted for AI in 2006 to 2007 to the ED of a Swiss tertiary hospital, further ED and PD inpatient admissions through 2013 were assessed. Patient characteristics at the index (initial) ED visit were assessed using administrative and medical records.

Evaluation of the discriminative performance of the prehospital National Advisory Committee for Aeronautics score regarding 48-h mortality.

Objective: The National Advisory Committee for Aeronautics (NACA) score is used by many emergency medical services to assess the severity of prehospital patients. Little is known about its discriminative performance regarding short-term mortality.

Participants And Methods: We retrospectively included adult missions between 2008 and 2014 in a Swiss ground and air-based emergency medical services.

Differences in triage category, priority level and hospitalization rate between young-old and old-old patients visiting the emergency department.

Background: Emergency Department (ED) are challenged by the increasing number of visits made by the heterogeneous population of elderly persons. This study aims to 1) compare chief complaints (triage categories) and level of priority; 2) to investigate their association with hospitalization after an ED visit; 3) to explore factors explaining the difference in hospitalization rates among community-dwelling older adults aged 65-84 vs 85+ years.

Methods: All ED visits of patients age 65 and over that occurred between 2005 and 2010 to the University of Lausanne Medical Center were analyzed.

Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study.

Background: Pelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate. The value of the pelvic fracture pattern for predicting transfusion requirements and mortality is not entirely clear. To address hemorrhage from pelvic injuries, the early application of pelvic binders is now recommended and arterial angio-embolization is widely used for controlling arterial bleeding.

Low sensitivity of qSOFA, SIRS criteria and sepsis definition to identify infected patients at risk of complication in the prehospital setting and at the emergency department triage.

Background: Sepsis is defined as life-threatening organ dysfunction caused by a host response to infection. The quick SOFA (qSOFA) score has been recently proposed as a new bedside clinical score to identify patients with suspected infection at risk of complication (intensive care unit (ICU) admission, in-hospital mortality). The aim of this study was to measure the sensitivity of the qSOFA score, SIRS criteria and sepsis definitions to identify the most serious sepsis cases in the prehospital setting and at the emergency department (ED) triage.

Mass Casualty Triage in the Case of Carbon Monoxide Poisoning: Lessons Learned.

ABSTRACTCarbon monoxide (CO) can cause mass intoxication, but no standard triage algorithm specifically addresses CO poisoning. The roles of some recent diagnostic tools in triage as well as treatment with hyperbaric oxygen are controversial. We describe a mass casualty case of CO poisoning involving 77 patients, with a focus on the triage and treatment options decided on-site.

Excited Delirium: A Systematic Review.

Objective: We aimed to clarify the definition, epidemiology, and pathophysiology of excited delirium syndrome (ExDS) and to summarize evidence-based treatment recommendations.

Methods: We conducted a systematic literature search of MEDLINE, Ovid, Web of Knowledge, and Cochrane Library for articles published to March 18, 2017. We also searched the gray literature (Google Scholar) and official police or medical expert reports to complete specific epidemiologic data.

Emergency department management of body packers and body stuffers.

Trafficking and sale of narcotics frequently involves the intra-abdominal transport of large quantities of drugs, usually cocaine or heroin ("body packing"), or, when there is a risk of being arrested, the oral ingestion of minor quantities of narcotics dedicated for immediate resale ("body stuffing"). This study aimed to describe the characteristics, complications and medical follow through of 132 cases of body packing (n = 36), cases of body stuffing (n = 83) or mixed cases (n = 13), referred by the authorities to our emergency department over the course of 12 years. Analysis of these 132 cases did not reveal any intra-abdominal rupture or leak of the packaging, or any case of acute intoxication.

Avoiding delayed diagnosis of significant blunt bowel and mesenteric injuries: Can a scoring tool make the difference? A 7-year retrospective cohort study.

Introduction: Significant blunt bowel and mesenteric injuries (sBBMI) are frequently missed despite the widespread use of computed tomography (CT). Early treatment improves the outcome related to these injuries. The aim of this study was to assess the prevalence of sBBMI, the incidence of delayed diagnosis and to test the performance of the Bowel Injury Prediction Score (BIPS), determined by the white blood cell (WBC) count, presence or absence of abdominal tenderness and CT grade of mesenteric injury.

[« Golden hour » and the Sellick manoeuvre in emergency care: we must not throw out the baby with the bathwater].

This article evaluates 3 controversial subjects of pre-hospital emergency care : 1) The concept of the « Golden hour » predicates an increased morbidity and mortality for injured patients, if pre-hospital care exceeds 1 hour. In the subgroup of patients presenting with severe hemorrhagic injuries or penetrating trauma to the torso, a transport of 60 minutes or less decreases mortality ; 2) The Sellick manoeuvre is used to decrease the risk of bronchoaspiration in patients undergoing an emergency intubation. In view of the low incidence of bronchoaspiration and the inherent risks of cricoid pressure, it should be used only in selected patients ; 3) Improvised cricothyroidotomy using non-medical devices may be feasible if a knife to perform an incision in the cricothyroid membrane and an endotracheal tube of sufficient diameter are available.

Antibiotic treatment for uncomplicated and mild complicated diverticulitis: outpatient treatment for everyone.

Purpose: Antibiotic treatment is the treatment of choice for uncomplicated diverticulitis (uD) and can be performed for mild complicated diverticulitis (mcD). In several cases, outpatient treatment (OT) can be undertaken. This study assessed the 1-month failure rate of OT for uD/mcD compared to inpatient treatment (IT), and identified predictive factors for treatment failure.

Mechanical restraint in an emergency department: a consecutive series of 593 cases.

The objective is to describe the characteristics of mechanically restrained patients in the emergency department (ED) of a university hospital and to evaluate the quality of restraint documentation that was filled out according to the dedicated protocol with respect to the law on restraint. All adult patients (≥16 years) who were admitted to the ED from January 2009 to December 2010 and were mechanically restrained were included. We assessed medical and demographic characteristics, the completeness of the dedicated protocol, and the concomitant use of chemical sedation.

Impact of the 2014-2015 influenza season on the activity of an academic emergency department.

The morbidity and mortality of the 2014-2015 influenza season were more important than those in previous years. We assessed the impact of the 2014-2015 influenza season on the length of stay (LOS) and workload in an academic emergency department (ED). This is a monocentric retrospective study.

Mushroom poisoning: a retrospective study concerning 11-years of admissions in a Swiss Emergency Department.

Wild mushroom intoxication is an unusual cause of toxic ingestion in Europe. A great diversity of clinical symptoms may arise depending on the variety of wild mushrooms ingested. These initial symptoms are often non-specific, with frequent gastrointestinal symptoms, and have no direct correlation with the outcome.

Prehospital Emergency Medical Services Departure Interval: Does Patient Age Matter?

Unlabelled: Introduction The concept of response time with minimal interval is intimately related to the practice of emergency medicine. The factors influencing this time interval are poorly understood. Problem In a process of improvement of response time, the impact of the patient's age on ambulance departure intervals was investigated.

Leadership and Teamwork in Trauma and Resuscitation.

Introduction: Leadership skills are described by the American College of Surgeons' Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs.

The probability of having advanced medical interventions is associated with age in out-of-hospital life-threatening situations.

Background: The use of out-of-hospital emergency medical services by old and very old individuals is increasing. These patients frequently require complex evaluation and decision-making processes to determine a strategy of care, therapeutic choices or withdrawal of care in life-threatening situations. During out-of-hospital missions, thorough decision-making is difficult because of the limited amount of time and lack of direct access to medical charts or to pre-existing advance directives.

Women and Men Admitted for Alcohol Intoxication at an Emergency Department: Alcohol Use Disorders, Substance Use and Health and Social Status 7 Years Later.

Aims: To assess the prevalence of alcohol use disorder (AUD), substance use, mental health and social status 7 years following an Emergency Department (ED) admission for alcohol intoxication. To assess gender differences in these prevalences.

Methods: Cohort of 631 patients aged 18-30 years admitted for alcohol intoxication in 2006-2007 at a tertiary referral hospital in Switzerland, contacted for an interview in 2014.

Retrospective analysis of 616 air-rescue trauma cases related to the practice of extreme sports.

Introduction: Extreme sports (ESs) are increasingly popular, and accidents due to ESs sometimes require helicopter emergency medical services (HEMSs). Little is known about their epidemiology, severity, specific injuries and required rescue operations.

Aim: Our aims were to perform an epidemiological analysis, to identify specific injuries and to describe the characteristic of prehospital procedures in ES accidents requiring HEMSs.

Nursing home residents at the Emergency Department: a 6-year retrospective analysis in a Swiss academic hospital.

The increasing number of elderly persons produces an increase in emergency department (ED) visits by these patients, including nursing home (NH) residents. This trend implies a major challenge for the ED. This study sought to investigate ED visits by NH residents in an academic hospital.

Focused use of drug screening in overdose patients increases impact on management.

Unlabelled: Drug poisoning is a common cause for attendance in the emergency department. Several toxicology centres suggest performing urinary drug screens, even though they rarely influence patient management.

Study Objectives: Measuring the impact on patient management, in a University Emergency Department with approximately 40 000 admissions annually, of a rapid urinary drug screening test using specifically focused indications.

Proposition and operational characteristics of a new dispatch scale to specifically identify acute strokes.

Objective: Prehospital recognition of an acute stroke improves the time from onset to thrombolysis and rates of reperfusion therapy. Studies conducted to evaluate paramedic and dispatcher performance in suspecting stroke are disappointing. This study addresses the specific issue of stroke recognition by dispatchers, taking into account delay in reporting the onset of symptoms (<5 h).

[Isolated chest trauma in elderly patients].

In elderly patients, a blunt trauma of the chest is associated with a significant risk of complications and mortality. The number of ribs fractures (≥ 4), the presence of bilateral rib fractures, of a pulmonary contusion, of existent comorbidities or acute extra-thoracic traumatic lesions, and lastly the severity of thoracic pain, are indeed important risk factors of complications and mortality. Their presence may require hospitalization of the patient.