[Pyogenic granuloma: a frequent and often misunderstood entity in primary care medicine]. / Botriomycome : une entité courante et souvent méconnue en médecine de premier recours.

Botriomycoma, also called pyogenic granuloma, is a common benign skin lesion that usually forms as a result of skin irritation. Although it is considered benign, its potential appearance as a malignant tumor can cause great concern in patients and lead to demand for prompt treatment. This article reviews the current knowledge about this lesion, including its possible causes, clinical manifestations, and treatment options.

Le botriomycome, aussi appelé granulome pyogénique, est une lésion cutanée bénigne courante qui se forme généralement à la suite d'une irritation de la peau. Bien qu'il soit considéré comme bénin, son apparence potentielle de tumeur maligne peut susciter une grande inquiétude chez les patients et entraîner une demande de traitement rapide. Cet article recense les connaissances actuelles sur cette lésion, y compris ses causes possibles, ses manifestations cliniques et les options de traitement.

[Wellens Syndrome: A rare entity not to be neglected]. / Syndrome de Wellens : une entité rare à ne pas méconnaître.

Wellens syndrome is a particular presentation of acute coronary syndrome which manifests, in a patient most often asymptomatic at the time of the examination, by specific electrocardiographic signs, in particular T waves in the precordial leads V2 and V3. The absence of chest pain at the time of the examination and the normality of cardiac enzymes can be falsely reassuring and constitute diagnostic pitfalls. This syndrome is associated with an often critical stenosis of the IVA (anterior descending artery). A good reading of the ECG is mandatory for the diagnosis. The management is done in interventional cardiology in order to avoid a massive anterior infarction.

Le syndrome de Wellens est une présentation particulière de syndrome coronarien aigu qui se manifeste chez un patient le plus souvent asymptomatique au moment de l'examen, par des signes électrocardiographiques spécifiques, notamment des ondes T dans les dérivations précordiales V2 et V3. L'absence de douleur thoracique et la normalité des enzymes cardiaques peuvent être faussement rassurantes et constituer des pièges diagnostiques. Ce syndrome est associé à une sténose souvent critique de l'IVA (artère interventriculaire antérieure). Une bonne lecture de l'ECG permet d'en faire le diagnostic. La prise en charge se fait en cardiologie interventionnelle afin d'éviter un infarctus antérieur massif.

[Anaphylaxis: an update]. / Anaphylaxie : mise à jour.

Anaphylaxis is the most severe form of acute systemic allergic reaction and can be fatal in the absence of adequate treatment with adrenaline. We propose to review the different mechanisms underlying anaphylaxis, as well as the diagnostic criteria and its management regarding the 2020 guidelines of the World Allergy Organization (WAO).

L'anaphylaxie est la forme la plus sévère de réaction allergique aiguë systémique et peut être fatale en l'absence d'un traitement adéquat par adrénaline. Nous proposons de revoir les différents mécanismes sous-jacents à l'anaphylaxie, ses critères diagnostiques ainsi que sa prise en charge à la lumière des directives 2020 de la World Allergy Organization (WAO).

[Point-of-care ultrasonography, update on practices and a concept of implementation in an emergency department]. / Echographie ciblée aux urgences†: état des lieux et concept d'implémentation.

Importance of bedside ultrasonography (BU) is growing in the emergency medicine. Many reasons support the use of the focused ultrasounds in the emergencies services such as : helping in diagnosis, improving invasive gestures and other treatments strategies. The implementation of a focused ultrasonography has a low financial impact but a high educational value. In despite of the existent education and training programs, the focused ultrasonography only has a low diffusion/practice in the emergency departments in Suisse romande. Here we describe the implementation on a focused ultrasonography program for our institution (HFR : Hôpital fribourgeois).

L'échographie ciblée est un outil essentiel dans la prise en charge des patients en médecine d'urgence. Utilisée comme complément de l'examen clinique elle constitue une aide au diagnostic, permet d'évaluer les traitements entrepris et de sécuriser les gestes invasifs. La mise en place d'un programme de formation à l'échographie ciblée a un faible impact financier mais une grande valeur éducative. En dépit de ses avantages et de l'existence de formations, on constate une faible diffusion de l'échographie ciblée dans les services d'urgences en Suisse romande. Nous écrivons ici le processus de mise en place d'un programme d'implémentation de l'échographie ciblée dans notre institution (HFR : Hôpital fribourgeois).

Monitoring Personalized Learning Curves for Emergency Ultrasound With Risk-adjusted Learning-curve Cumulative Summation Method.

BACKGROUND: Ultrasound (US) has been a regular practice in emergency departments for several decades. Thus, train our students to US is of prime interest. Because US image acquisition ability can be very different from a patient to another (depending on image quality), it seems relevant to adapt US learning curves (LCs) to patient image quality using tools based on cumulative summation (CUSUM) as the risk-adjusted LC CUSUM (RLC). OBJECTIVES: The aim of this study was to monitor LC of medical students for the acquisition of abdominal emergency US views and to adapt these curves to patient image quality using RLC. METHODS: We asked medical students to perform abdominal US examinations with the acquisition of 11 views of interest on emergency patients after a learning session. Emergency physicians reviewed the student examinations for validation. LCs were plotted and the student was said proficient for a specific view if his LC reached a predetermined limit fixed by simulation. RESULTS: Seven students with no previous experience in US were enrolled. They performed 19 to 50 examinations of 11 views each. They achieve proficiency for a median of 9 (6-10) views. Aorta and right pleura views were validated by seven students; inferior vena cava, right kidney, and bladder by six; gallbladder and left kidney by five; portal veins and portal hilum by four; and subxyphoid and left pleura by three. The number of US examinations required to reach proficiency ranged from five to 41 depending on the student and on the type of view. LC showed that students reached proficiency with different learning speeds. CONCLUSIONS: This study suggests that, when monitoring LCs for abdominal emergency US, there is some heterogeneity in the learning process depending on the student skills and the type of view. Therefore, rules based on a predetermined number of examinations to reach proficiency are not satisfactory.