[Emergency unilateral mydriasis]. / Mydriase unilatérale aux urgences.

UNLABELLED: UNEQUAL PUPILS: Or anisocoria is frequent and can be physiological, benign or life threatening. VARIATIONS IN THE PUPIL: Constriction depends on the parasympathetic system and dilatation on the sympathetic system. IN PARASYMPATHETIC DISORDERS: Peripheral or central neurological causes can be distinguished, among which acute cerebral lesions with compression of the trunk are the most dramatic. Differential diagnosis can be made by studying the local causes, which may represent ophthalmologic emergencies (acute glaucoma or lesions of the retina). AMONG THE SYMPATHETIC DISORDERS: Claude-Bernard-Horner's syndrome is the most classical example. Other particular cases exist, such as Adie's pupil, affecting young women (1/20,000), associating mydriasis and occasionally tendinous areflexia. Diagnosis is generally confirmed by the ophthalmologist, following a normal or evocative of the disease neurological examination. IN PRACTICE: Rapid but careful clinical examination permits orientation of the diagnosis and appropriate treatment.

[Short emergency hospitalization]. / L'hospitalisation de courte durée à l'urgence.

In France, the number of admissions to emergency departments increase by 5 to 10 per cent per year. Traditionally, patients who require services beyond the first hours in the emergency department have been admitted to the acute care hospital. Observation unit are becoming common in hospitals because they allow an additional option to admission or discharge. In France, 60 per cent of emergency departments have observation units. Five to ten per cent of patients seen in an emergency department are transferred to the observation unit. These observation units are staffed with emergency personnel specifically assigned to the function of the unit. The average period of observation is less than 48 h. Of the patients observed, 50 per cent are discharged after extended observation and treatment. These observation units can be a safe, effective and cost-saving way of ensuring that patients who are considered to be in an intermediate category receive appropriate care.