Predicting acute coronary syndrome in males and females with chest pain who call an emergency medical communication centre.

Background: Chest pain is a frequent reason for calls in emergency medical communication centre (EMCC). Detecting a coronary origin by phone is a challenge. This is especially so as the presentations differ according to gender.

Treatment of Acute Renal Colic in US and French EDs: Simulated Cases and Real Cases in Acute Pain Management.

Objectives: To assess the prescribing patterns in acute renal colic in emergency departments in US and France, by comparing physicians' intended prescription practices with actual prescription data in a sample of emergency practitioners.

Methods: Pharmaco-epidemiological international study in two phases. First, we surveyed emergency physicians in US and France as to what analgesics they would use for simulated cases of renal colic.

Management of non-traumatic chest pain by the French Emergency Medical System: Insights from the DOLORES registry.

Background: The early recognition of acute coronary syndromes is a priority in health care systems, to reduce revascularization delays. In France, patients are encouraged to call emergency numbers (15, 112), which are routed to a Medical Dispatch Centre where physicians conduct an interview and decide on the appropriate response. However, the effectiveness of this system has not yet been assessed.

[Disaster medicine, organization and management].

A disaster situation requires an organised command of the emergency services as well as of the treatment of victims and their orientation. The aim is to avoid any deterioration in the quality of the emergency care provided to the patients. A medical speciality, disaster medicine requires specific training.

Nitrous oxide for early analgesia in the emergency setting: a randomized, double-blind multicenter prehospital trial.

Objectives: Although 50% nitrous oxide (N(2) O) and oxygen is a widely used treatment, its efficacy had never been evaluated in the prehospital setting. The objective of this study was to demonstrate the efficacy of premixed N(2) O and oxygen in patients with out-of-hospital moderate traumatic acute pain.

Methods: This prospective, randomized, multicenter, double-blind trial enrolled patients with acute moderate pain (numeric rating scale [NRS] score between 4 and 6 out of 10) caused by trauma.

Morbidity and mortality conferences in emergency departments: the French National Survey.

In France, emergency departments (EDs) are not yet required to implement Morbidity and Mortality Conferences (M&MCs), but it is likely that they will soon be a requirement. We conducted a national survey through e-mail to evaluate current M&MC practices in EDs in France. Of the 232 questionnaires sent out, 149 responses were analyzed (64%).

Stent for Life in France.

France was chosen to be one of the six first pilot countries of the "Stent for Life" European initiative. First, a prospective registry was set up in five representative French regions, including all admissions within the first 48 hours of ST-elevated acute cardiac syndrome between 1st and 30th November 2010. The second step was to improve results.

New diploma in emergency medicine in France: the students' perspective.

French emergency medicine (EM) has undergone rapid changes with the establishment of a diploma in emergency medicine (DES). We aimed to question medicine students on their knowledge of and apprehensions regarding this new DES. We conducted an email cross-sectional survey among second-cycle medical students before their choice of resident speciality.

Compliance with guidelines in patients with ST-segment elevation myocardial infarction after implementation of specific guidelines for emergency care: results of RESCA+31 registry.

Background: Guidelines emphasize the implementation of local networks with prehospital emergency medical systems to improve the management of patients with ST-segment elevation myocardial infarction (STEMI); they also define the choice of reperfusion strategies and adjunctive treatments.

Aim: To assess the compliance of STEMI emergency care with current French guidelines in a large area of France and to identify predictors of compliance with guidelines.

Method: The RESCA+31 registry was a 2-year, multicentre, prospective, multidisciplinary study, including 512 consecutive patients with STEMI evolving within 12 hours managed by emergency physicians in the prehospital system or emergency department.

User satisfaction with maritime telemedicine.

We assessed the satisfaction of onboard caregivers with the maritime telehealth service provided by the Centre de Consultations Médicales Maritimes (CCMM). We conducted a survey of captains and caregivers by email. Of the 385 surveys sent out, 165 (43%) were completed.

Diagnostic accuracy of quantitative heart-fatty acid binding protein assays compared with Cardiodetect(®) in the early detection of acute coronary syndrome.

Background: Heart-fatty acid binding protein (h-FABP) has been proposed as a cardiac marker for the early detection of acute coronary syndrome (ACS). In a study of 677 patients admitted to the emergency department (ED) for chest pain, we found that a semiquantitative point-of-care test that detects h-FABP (Cardiodetect(®)) had low sensitivity for the prediction of ACS.

Objective: The aim of this ancillary study was to analyze and compare the performance of h-FABP for early ACS diagnosis in this large cohort of unselected patients, using a quantitative immunoassay and Cardiodetect(®).

Use of morbidity and mortality conferences to analyze causes of death at sea: a useful tool in the process of training in maritime medicine.

BACKGROUND. Morbidity and mortality conferences (MandMC) are collective reviews of records of patients, whose evolution was marked by an undesirable event: death or the occurrence of complications. The MandMC aim to improve the quality of care.

Cardiovascular diseases and electrocardiogram teletransmission aboard ships: the French TMAS experience.

Background: The aim of this study was to analyse emergency calls for teleconsultation received at French TMAS relating to cardiovascular pathologies, to assess the relevance of electrocardiogram teletransmission.

Material And Methods: A two-year descriptive and retrospective study from the TMAS medical files database. We selected patients whose telemedical request was related to a possible cardiovascular pathology.

Continuous positive airway pressure for cardiogenic pulmonary edema: a randomized study.

Study Objective: The purpose of this randomized controlled trial was to determine the immediate and delayed effects of noninvasive ventilation for patients in acute cardiogenic pulmonary edema (ACPE) in addition to aggressive usual care in a medical prehospital setting.

Methods: Out-of-hospital patients in severe ACPE were eligible for the study. Patients were randomized to receive either usual care, including conventional optimal treatment with furosemide, oxygen, and high-dose boluses of isosorbide dinitrate plus oxygen, or conventional medications plus out-of-hospital continuous positive airway pressure (CPAP).

Predictors of pain relief and adverse events in patients receiving opioids in a prehospital setting.

Objective: The aim of the study was to analyze factors predicting pain relief and adverse events in patients receiving opioids for acute pain in a prehospital setting.

Methods: In this prospective, observational clinical study, adult patients with a numerical rating scale (NRS) score of 5 of 10 or higher who required treatment with intravenous opioids for pain control were included. The primary outcome variable was final analgesia defined by an NRS score of 3 of 10 or lower upon arrival to the emergency department.

Generalized convulsive status epilepticus management in adults: a cohort study with evaluation of professional practice.

Purpose: Generalized convulsive status epilepticus (GCSE) needs immediate management. Despite guidelines, adherence to management protocols is often poor, this contributing to poor outcome. We aimed to evaluate the usefulness of a management protocol in GCSE.

Usefulness of initial glucose level to improve acute coronary syndrome diagnosis in the emergency department.

Introduction: The aim of the study was to analyse the incremental usefulness of high blood glucose level for non-ST elevation acute coronary syndrome (ACS) diagnosis in patients admitted to the emergency department (ED) for chest pain and suspected ACS.

Methods: A post hoc analysis of a prospective, observational study of 11 months duration was carried out. Initial glucose levels were analysed in 672 consecutive patients admitted to the ED with chest pain and suspected non-ST elevation ACS.

Sufentanil is not superior to morphine for the treatment of acute traumatic pain in an emergency setting: a randomized, double-blind, out-of-hospital trial.

Study Objective: We determine the best intravenous opioid titration protocol by comparing morphine and sufentanil for adult patients with severe traumatic acute pain in an out-of-hospital setting, with a physician providing care.

Methods: In this double-blind randomized clinical trial, patients were eligible for inclusion if aged 18 years or older, with acute severe pain (defined as a numeric rating scale score ≥ 6/10) caused by trauma. They were assigned to receive either intravenous 0.

Pancreatic cholangiocarcinoma as an ST-elevation myocardial infarction with thrombolytic therapy.

We report the case of a 46-year-old patient who presented a chest pain with ST-segment elevation in precordial leads V1 (2 mm), V2 (4 mm), and V3 (3 mm). Thrombolytic therapy was initiated with the combination tenecteplase tissue plasminogene activator, aspirin, and heparin. Further electrocardiogram and cardiac enzymes measured every 2 hours during the first 24 hours remained normal, and after a computed tomography of the abdomen, the patient was taken to surgery for an exploratory abdominal operation that revealed pancreatic cholangiocarcinoma.

Clinical assessment of ischemia-modified albumin and heart fatty acid-binding protein in the early diagnosis of non-ST-elevation acute coronary syndrome in the emergency department.

Objectives: Heart fatty acid-binding protein (h-FABP) and ischemia-modified albumin (IMA) have recently been evaluated, but to the best of our knowledge, no study has reported an analysis of these two markers for the detection of early myocardial infarction and myocardial ischemia in a large cohort of consecutive patients presenting to an emergency department (ED). This study evaluates the diagnostic accuracy and the clinical utility of h-FABP and IMA for non-ST-segment elevation acute coronary syndrome (ACS) diagnosis in the first hour of management in an ED.

Methods: In a prospective 11-month study, 677 patients admitted to the ED with chest pain and suspected non-ST-segment elevation ACS were enrolled.

Prehospital mechanical ventilation of a critical cardiac tamponade.

Mechanical ventilation of a critical cardiac tamponade is a high-risk situation that can lead to asystolic cardiac arrest. We report a prehospital mechanical ventilation of a penetrating cardiac injury complicated with tamponade. Onset diagnosis of the circulatory arrest allowed by prehospital continuous ultrasonography led to earlier initiation of the resuscitation and might have favored successful outcome.

Rupture of splenic artery aneurysm during early pregnancy: a rare and catastrophic event.

Spontaneous rupture of splenic artery aneurysm during pregnancy is a rare, life-threatening event with a catastrophic prognosis. Splenic artery aneurysm, known to be more frequent in women, especially among multiparous ones, is generally asymptomatic until rupture. Because of increased blood flow and hormonal modifications, this rupture occurs frequently during pregnancy, most often at the end of the third trimester.