Contribution of the FilmArray Respiratory Panel in the management of adult and pediatric patients attending the emergency room during 2015-2016 influenza epidemics: An interventional study.

AIM: To evaluate the contribution of a multiplex PCR for respiratory viruses on antibiotic and antiviral prescription, ancillary test prescription, admission and length of stay of patients. METHODS: Two hundred ninety-one adult and pediatric patients visiting the emergency department during the 2015-2016 influenza epidemic were prospectively included and immediately tested 24/7 using the FilmArray Respiratory Panel. The results were communicated to the practitioner in charge as soon as they became available. Clinical and biological data were gathered and analyzed. FINDINGS: Results from the FilmArray Respiratory Panel do not appear to impact admission or antibiotic prescription, with the exception of a lower admission rate for children who tested positive for influenza B. Parameters that account for the clinical decisions evaluated are CRP level, white blood cell count, suspected or proven bacterial infection and, for adult patients only, signs of respiratory distress. Length of stay is also not significantly different between patients with a positive and a negative result. A rapid influenza test result permits a more appropriate prescription of oseltamivir.

Does endotracheal intubation increases chest compression fraction in out of hospital cardiac arrest: A substudy of the CAAM trial.

BACKGROUND: Optimal out of hospital cardiac arrest (OHCA) airway management strategies remain unclear. We compared chest compression fraction (CCF) between patients receiving endotracheal intubation (ETI) versus bag mask ventilation (BMV). METHODS: We studied adult OHCA enrolled from our center in the CAAM trial. Primary exposures were ETI or BMV. Primary outcome was whole intervention CCF, adjusted for Utstein confounders. Secondary outcomes were per cycle CCF, no flow time associated (NFT) with ventilation, rhythms checks and mechanical chest compression device placement. RESULTS: Of 2040 OHCA enrolled in the CAAM trial we analyzed 112 cases recruited by our center. Unadjusted CCF was 0.89 for ETI and 0.88 for BMV (p = 0.19). Compared with BMV, ETI achieved lower NFT associated with ventilations (32 vs 127 s; p < 0.001). ETI cases experienced higher NFT associated with rhythm checks (69.5 vs 42.5 s p = 0.02) and with mechanical chest compression placement (29 vs 20 s; p = 0.04). CCF was higher during the first cycle in BMV than in ETI patients (0.81 vs 0.74; p = 0.02). After correction for confounders we observed no difference in global intervention CCF between the ETI and BMV (ΔCCF [ETI-BMV] 0.301; [95%CI: -1.9 to 2.51]; p = 0.79). CONCLUSION: In our substudy whole intervention CCF among OHCA was not modified by ETI compared to BMV. In the ETI group we observed lower NFT associated with ventilations and higher NFT associated with mechanical chest compression devices placement. CCF was lower in the ETI group during the first cycle.

Prospective evaluation of diagnostic tools for respiratory viruses in children and adults.

AIM: To compare the performances of molecular and non-molecular tests to diagnose respiratory viral infections and to evaluate the pros and contras of each technique. METHODS: Two hundred ninety-nine respiratory samples were prospectively explored using multiplex molecular techniques (FilmArray Respiratory Panel, Clart Pneumovir), immunological techniques (direct fluorescent assay, lateral flow chromatography) and cell cultures. FINDINGS: Molecular techniques permitted the recovery of up to 50% more respiratory pathogens in comparison to non-molecular methods. FilmArray detected at least 30% more pathogens than Clart Pneumovir which could be explained by the differences in their technical designs. The turnaround time under 2 hours for the FilmArray permitted delivery of results when patients were still in the emergency room.

[Bleeding induced by Selective Serotonine Reuptake inhibitors (SSRI). Case report and review of literature]. / Syndromes hémorragiques sous antidépresseurs inhibiteurs sélectifs de la recapture de la sérotonine (ISRS). À propos de deux cas et revue de la littérature.

Selective serotonin re-uptake inhibitors are widely prescribed on a daily basis due to their recognized efficiency and their few side effects as opposed to tricyclic antidepressants. The iatrogenic effect mainly causes benign hemorrhagic episodes however some cases could get serious. The Belgian centre of pharmacotherapeutical information warns prescribing physicians regarding the use of SSRIs. The existing risk of cutaneo-mucosal bleeding or other forms of hemorrhage due to SSRIs has been identified in the early 90s based on reported cases. Since then, cohort epidemiology studies or case studies have shown a correlation between the SSRIs intake and bleeding, linked to inhibition of the serotonin re-uptake (5HT). We report 2 clinical cases of patients who presented hemorrhages. One has been taking sertraline and the other fluoxetine. Through this literature review, we aim at discussing the impact of the different physiopathologic mechanisms.

Les antidépresseurs Inhibiteurs Sélectifs de la Recapture de la Sérotonine (ISRS) sont largement prescrits au quotidien pour leur efficacité reconnue et leur moindres effets secondaires par rapport aux antidépresseurs tricycliques. Parmi les effets iatrogènes, on note des épisodes hémorragiques bénins qui peuvent parfois présenter un caractère de gravité. Le Centre Belge d'Information Pharmaco-thérapeutique (C.B.I.P)1 met en garde les prescripteurs quant à l'utilisation des ISRS. L'existence d'un risque de saignement cutanéo-muqueux ou d'autres formes d'hémorragie avec les ISRS a été identifiée au début des années 90 sur base de cas rapportés. Depuis lors, des études épidémiologiques de cohortes ou cas-témoins ont mis en évidence une association entre la prise d'ISRS et la survenue d'une hémorragie, liée à l'inhibition du recaptage de la sérotonine (5 HT). Nous rapportons deux cas cliniques de patients qui ont présenté des hémorragies, l'un sous sertraline et l'autre sous fluoxétine, afin de discuter à travers une revue de la littérature, l'incidence et les différents mécanismes physiopathologiques.

[About a cresol intoxication]. / A propos d'une intoxication aux crésols.

Cresols are phenol derivatives commonly used as surface disinfectants. Ingestion may cause local mucocutaneous damage and extensive systemic toxicity : central nervous, cardiovascular, hematological, hepatic, renal and pulmonary. We describe the case of a 33-year-old woman who swallowed, without suicidal intent, 50 to 70 cm3 of a 50% cresol solution. Coma occurred within 5 minutes of ingestion, she presented a bradypnea with desaturation, and the SMUR team performed on-site an orotracheal intubation. On arrival at the hospital, the patient had typical caustic lesions around her mouth. Immediate management consisted of ventilatory support, instillation of activated charcoal by nasogastric tube, empirical intravenous methylene blue and effective vascular filling. Within one hour of admission, she developed hypotension, ventricular arrhythmias, and acute renal failure. Toxic hepatitis occurred within 24 hours. The 24-hour gastroscopy showed erosive esophagitis and erythematous gastropathy and duodenopathy. No urine or blood dosage can be performed. The patient left the hospital on the fifth day and her liver function normalized after one month. The treatment of phenol poisoning consists primarily of rapid decontamination and the support of vital functions. Diagnostic assays are not available routinely and anamnesis, as well as some semiological cardinal points, is essential.

Les crésols sont des dérivés de phénol communément utilisés comme désinfectants de surfaces. Leur ingestion peut causer des dommages cutanéomuqueux locaux ainsi qu'une toxicité systémique étendue : nerveuse centrale, cardiovasculaire, hématologique, hépatique, rénale et pulmonaire. Nous décrivons le cas d'une femme de 33 ans ayant ingéré sans intention suicidaire, 50 à 70 cm3 d'une solution crésolique à 50 %. Le coma est survenu dans les 5 min suivant l'ingestion, elle présentait une bradypnée avec désaturation et l'équipe de SMUR a procédé à l'intubation orotrachéale sur place. A l'arrivée à l'hôpital, la patiente présentait des lésions caustiques typiques sur le pourtour de la bouche. La prise en charge immédiate a consisté en une assistance ventilatoire, instillation de charbon activé par sonde nasogastrique, bleu de méthylène empirique intraveineux et remplissage vasculaire efficace. Dans l'heure suivant son admission, elle a présenté une hypotension artérielle, des troubles de rythme ventriculaire et une insuffisance rénale aiguë. Une hépatite toxique s'est révélée dans les 24 h suivantes. La gastroscopie à 24 h mettra en évidence une oesophagite érosive et une gastropathie et duodénopathie érythémateuses. Aucun dosage urinaire ou sanguin n'a pu être pratiqué. La patiente quittera l'hôpital au cinquième jour et sa fonction hépatique se normalisera après un mois. Le traitement de l'intoxication aux phénols consiste avant tout en une décontamination rapide ainsi qu'en le support des fonctions vitales. Les dosages diagnostiques ne sont pas disponibles en routine et l'anamnèse, ainsi que quelques points sémiologiques cardinaux, sont primordiaux.

[Pseudotumor cerebri due to taking minocycline]. / Pseudotumeur cérébrale due à la prise de minocycline.

The cerebral pseudotumor (PTC) is defined by the increase in cerebrospinal fluid (CSF) pressure, a normal composition of the latter in the absence of identified intracranial structural abnormalities, in particular by neuroimaging. The pathophysiology of PTC is poorly understood although its diagnostic criteria are well established. Drugs such as minocycline, tetracycline and doxycycline have been repeatedly implicated as a causative factor in PTC. The prognosis of PTC related to minocycline, reported in the literature is quite variable. Some authors suggest a benign condition with spontaneous healing by stopping the antibiotic, while others report permanent loss of vision. A 12-year-old girl is admitted to the emergency room for progressively progressive pulsatile temporal headaches associated with diplopia. The patient reported the use of minocycline 50 mg / d for five months, prescribed by her attending physician as part of an acne treatment. PTC will be demonstrated by severe papillary edema and cerebral NMR will demonstrate an enlargement of the subarachnoid space around the optic nerves. After three lumbar punctures, the condition of the patient stabilized and there was a marked improvement in headache despite the persistence of bilateral papillary edema. This work describes a clinical case of PTC induced by the use of minocycline and reviews the physiopathology, the diagnosis and the management of this one.

La pseudotumeur cérébrale (PTC) est définie par l'augmentation de la pression du liquide céphalo- rachidien (LCR), une composition normale de ce dernier en l'absence d'anomalies structurelles intracrânienne identifiée, en particulier par neuro- imagerie. La physiopathologie de la PTC est mal comprise bien que ses critères de diagnostic soient bien établis. Les médicaments tels que la minocycline, la tétracycline et la doxycycline ont été mis à plusieurs reprises en cause comme un facteur causal dans la PTC. Le pronostic de PTC lié à la minocycline, rapporté dans la littérature est tout à fait variable. Certains auteurs suggèrent une affection bénigne avec une guérison spontanée par l'arrêt de l'antibiotique, tandis que d'autres signalent une perte de vision permanente. Une jeune fille de 12 ans est admise aux urgences pour des céphalées temporales pulsatiles apparues de manière progressive, associée à de la diplopie. La patiente rapporte la prise de minocycline 50 mg/j depuis cinq mois, prescrite par son médecin traitant dans le cadre d'un traitement contre l'acné. La PTC sera objectivée par un œdème papillaire sévère et la RMN cérébrale mettra en évidence un élargissement de l'espace sous-arachnoïdien autour des nerfs optiques. Après réalisation de trois ponctions lombaires de décharge, l'état de la patiente s'est stabilisé et on note une nette amélioration des céphalées malgré la persistance de l'œdème papillaire bilatéral. Ce travail décrit un cas clinique de PTC induite par la prise de minocycline et revoit la physiopathologie, le diagnostic et la prise en charge de celle-ci.

[Acute colonic diverticulitis : outcome according to general practice management prior to referral and criteria predictive of complications. A 10-year experience in a University Hospital]. / Diverticulite aiguë du colon : devenir en fonction de la prise en charge préalable en médecine générale et critères prédictifs de complications. Expérience sur 10 ans dans un C.H.U.

INTRODUCTION: Ambulatory treatment of acute uncomplicated diverticulitis has been shown to be safe and effective by several recent studies. The aim of our study was to analyze the outcome of general practice management concerning the complications, the treatment modalities and the hospitalization duration during the first episode of acute diverticulitis. MATERIEL AND METHODS: A total of 176 medical files of patient presenting between January 2000 and December 2010 at the emergency department with a first episode of acute diverticulitis confirmed by an abdominal CT scan were analyzed. Among the 160 patients fulfilling the inclusion criteria, 50 were referred by a general practitioner (GP). Data concerning admission modalities, clinical status, paraclinic investigations, complications, treatment and length of hospital stay were reviewed. RESULTS: The patients referred by the GP were significantly older (p ⟨ 0.001) and were hospitalized significantly longer (p = 0.034) than the patients consulting directly the emergency department. There was a significant correlation between the 2 variables (R = 0.406). Complications and treatment modalities did not differ between the two groups. Complicated diverticulitis was associated with rebound (p = 0.049), tenderness (p = 0.005) and a time interval between initial symptoms onset and admission to the emergency department superior to 4 days (p = 0.027). CONCLUSIONS: Ambulatory management of acute diverticulitis by the GP does not affect the outcome of the patients after their hospital admission in term of complications and treatment modalities. Ambulatory treatment of acute diverticulitis is safe but hospitalization is indicated in case of poor clinical tolerance, presence of rebound, tenderness and duration of symptoms for more than 4 days.

INTRODUCTION: Le traitement ambulatoire des diverticulites non compliquées est efficace et recommandé dans plusieurs études. Le but de notre étude était d'analyser l'impact de la prise en charge en médecine générale sur les complications, les modalités de traitement et la durée d'hospitalisation lors d'un premier épisode de diverticulite. MATERIEL: 176 dossiers ont été analysés. Parmi les 160 patients retenus, 50 étaient adressés par un médecin traitant. Les critères d'inclusion étaient : admission via les urgences avec un premier épisode de diverticulite confirmé par au moins un CT scanner. Les données analysées étaient l'anamnèse, les paramètres cliniques et paracliniques, les complications, les traitements et la durée d'hospitalisation. RESULTATS: Les patients adressés par le médecin traitant ont une durée d'hospitalisation plus longue (p = 0,034) et sont plus âgés (p ⟨ 0,001) que ceux se présentant directement aux urgences avec une corrélation significative entre les 2 variables (R = 0,406). Aucune différence significative n'a été retrouvée en termes de complications et de modalités de traitement entre les deux groupes. Le rebond (p = 0,049), la défense (p = 0,005), et un délai entre le début des plaintes et l'admission aux urgences supérieures à 4 jours (p = 0,027) étaient les facteurs associés à une diverticulite compliquée. CONCLUSION: La prise en charge en médecine générale des diverticulites aiguës ne modifie pas le devenir des patients lors de leur admission à l'hôpital en termes de complications et de modalités de traitement. Le traitement ambulatoire des diverticulites simples est recommandé, mais en cas de mauvaise tolérance clinique, telle que la présence d'un rebond, d'une défense et des symptômes de plus de 4 jours, une hospitalisation est indiquée et justifiée.

[Genesis of specific multisite Medical Intervention Plans in the Brussels Capital Region]. / Naissance du Plan d'Intervention médicale multisites de la Région de Bruxelles-Capitale.

After the november 19th 2015 Paris terrorist attacks, there was a clear need to update the Medical Intervention Plans (MIP) for Mass Casualty Events (MCE) in the Brussels Capital Region (BCR), because they only offered a response to single-site MCE in a peace-time context. We compared the organisation and the resources of the BCR and cities like Paris and Lille, we discussed with our french colleagues and formed a Multisite Attack Task-force that produced a specific multisite MIP, which had to be put to use only a few days after its creation.

Les attentats de Paris du 19 novembre 2015 ont mis en avant la nécessité de revoir le Plan d'Intervention médicale (PIM) en cas de catastrophe dans la Région de Bruxelles-Capitale (RBC) car il était axé sur des évènements survenant au niveau d'un seul site et dans un contexte de paix civile. La comparaison de l'organisation et des moyens des villes française comme Paris et Lille, la discussion avec nos collègues français et au sein du Groupe de Travail Attentats Multisites RBC ont permis d'aboutir à Bruxelles à la finalisation d'un PIM multisites qui a été mis à l'épreuve seulement quelques jours après sa création.

[Evaluations by hospital-ward physicians of patient care management quality for patients hospitalized after an emergency department admission]. / Evaluation par le médecin de salle de la qualité de la prise en charge médicale des patients hospitalisés via le Service des Urgences.

BACKGROUND: patient management in the acute and sub-acute setting of an Emergency Department is challenging. An assessment of the quality of provided care enables an evaluation of failings. It contributes to the identification of areas for improvement. OBJECTIVES: to obtain an analysis, by hospital-ward physicians, of adult patient care management quality, as well as of the correctness of diagnosis made during emergency admissions. To evaluate the consequences of inadequate patient care management on morbidity, mortality and cost and duration of hospitalization. METHODS: prospective data analysis obtained between the 1/12/2009 and the 21/12/2009 from physicians using a questionnaire on adult-patient emergency admissions and subsequent hospitalization. RESULTS: questionnaires were completed for 332 patients. Inadequate management of patient care were reported for 73/332 (22 %) cases. Incorrect diagnoses were reported for 20/332 (6 %) cases. 35 cases of inadequate care management (10.5 % overall) were associated with morbidity (34 cases) or mortality (1 case), including 4 cases (1.2 % ) that required emergency intensive-care or surgical interventions. CONCLUSION: this quality study analyzed the percentage of patient management cases and incorrect diagnoses in the emergency department. The data for serious outcome and wrong diagnosis are comparable with current literature. To improve performance, we consider the process for establishing a diagnosis and therapeutic care.

OBJECTIFS: analyser la qualité de la prise en charge médicale et l'adéquation des diagnostics des patients admis en urgence par les spécialistes des unités de soins. En évaluer les conséquences sur la morbidité, la mortalité, le coût et la durée d'hospitalisation. MATERIEL ET METHODES: sur une période s'échelonnant du 1/12/2009 au 21/12/2009, nous avons prospectivement analysé, sur base d'un questionnaire, les constatations émises par les spécialistes des salles sur 332 patients adultes admis à l'hôpital via le Service des Urgences. Les critiques sur la qualité de la prise en charge se fondent, subjectivement, sur l'avis des spécialistes des salles. RESULTATS: les pourcentages de prises en charge inadéquates et d'erreurs diagnostiques sont respectivement de 22 % et de 6 %. Parmi les 22 % des prises en charge inadéquates, 10,5 % présentent des conséquences en termes de morbidité, coût et durée d'hospitalisation, 1,2 % ont été repris in extremis par les intensivistes et les chirurgiens, on note 1 décès. CONCLUSION: cette étude qualité analyse le pourcentage de prises en charge et de diagnostics adéquats au sein du Service des Urgences. Les erreurs diagnostiques et leurs conséquences sont comparables à celles retrouvées dans la littérature. Une réflexion sur les processus cognitifs d'élaboration du diagnostic et les prises en charge thérapeutiques est entreprise pour améliorer nos performances.

Adrenaline in anaphylaxis treatment and self-administration: experience from an inner city emergency department.

BACKGROUND: Anaphylaxis is a life-threatening emergency of which reliable epidemiological data are lacking. This study aimed to analyze how quickly patients presenting with anaphylaxis were treated in emergency and whether treatment followed the European Academy of Allergy and Clinical Immunology (EAACI) guidelines. METHODS: Patient data were collected between April 2009 and April 2013. Emergency doctors completed a questionnaire for adult patients presenting at the emergency department (ED) of the St. Pierre hospital in Brussels with anaphylaxis. Inclusion criteria were based on the Sampson criteria of anaphylaxis. Data were analyzed using a Microsoft Excel database. RESULTS: About 0.04% (100/230878) of all emergency visits in adults presented with anaphylaxis. 64% of patients received their first medical help later than 30 min after symptom onset. 67% of patients received adrenaline, 85% oral antihistamines, and 89% received IV glucocorticosteroids. 46/100 patients were discharged directly from the ED, of which 87% received further medical prescriptions for self-administration: 67% corticosteroids, 83% antihistamines, and 9% intramuscular adrenaline. 74% were instructed to consult an allergologist for adequate diagnosis. 54/100 patients were hospitalized. CONCLUSION: The majority of patients were treated according to the EAACI guidelines for management of anaphylaxis, but only a minority received the recommended adrenaline auto-injector for self-administration at discharge. Because the majority of patients received medical help later than 30 min after symptom onset, adrenaline auto-injector prescription is a necessity. The low rate of doctors prescribing adrenaline auto-injectors in the ED setting underlines the need to train doctors of various backgrounds in prevention and treatment of anaphylaxis and the close collaboration with allergologists.

[Not Available]. / De l'utilité des dispositifs préventifs lors des manifestations de masse. Pertinence d'un outil d'encodage.

The implementation of preventive devices is always a difficult task to anticipate. It is also difficult to verify the adequacy of resources used to the needs. For this purpose, the Belgian Red Cross created the computer tool collecting administrative information, diagnostic codes, destination of the patient, triage, level of emergency as well as kinetics of admission to the preventive care station. Data analysis in the various types of events confirms the usefulness of prevention devices. Although it can be improved, the tool is reliable and permits a great extent the adaptative means to the needs.

Anaphylaxis in an urban Belgian emergency department: epidemiology and aetiology.

OBJECTIVES: Anaphylaxis is an emergency condition of which reliable epidemiological data are lacking. This study focusses on epidemiology and aetiology of anaphylactic reactions in an urban Belgian emergency department (ED). METHODS: Patient data were collected from 04/2009 to 04/2013.During this period, emergency doctors completed a questionnaire for adult patients (>15 years) with anaphylaxis presenting at the ED. Inclusion criteria were based on the Sampson criteria of anaphylaxis. Data were analysed using a Microsoft Excel database. RESULTS: Anaphylaxis accounted for 0.04% of all emergency visits in this 4-year period. In both women and men, dyspnoea and urticaria were noted most frequently. 51.7% of cases were possibly elicited by foods, 46.1% by drugs and 3.4% by hymenoptera stings. Women more often reported allergic diseases in their personal history. 55.7% of patients, who had a history of allergy, reported a suspected food-related allergy, 24.6% a drug-related allergy and 8.2% a hymenoptera venom-related allergy. In 76.5% of patients who reported a history of food allergy, food was the presumed elicitor of anaphylaxis. For patients with history of drug allergy, 88.2% had a presumed drug anaphylaxis at the time of presentation at the ED. 81% of cases presented with grade 4 or 5 anaphylaxis. With increasing age, the severity of anaphylaxis increased. Higher tryptase levels correlated with a higher grade of anaphylaxis. CONCLUSION: In this Belgian urban population, foods and drugs were by far the most common suspected elicitors of anaphylaxis. Personal history of allergic diseases was present in more than half of the cases.

[Furuncular myiasis: Case report of a cutaneous parasitosis usually considered as an abscess]. / La myiase furonculeuse: Cas clinique d'une parasitose cutanée souvent confondue avec un abcès.

Furuncular myiasis is a wel l established cutaneous parasitosis in tropical area. In Europe, most of cases have been described in patients returning from risk areas. We report a case of a 4-year old child with a furuncular lesion on his left thigh considered as an abscess and who was send to emergency department for surgical drainage.

La myiase furonculeuse est une parasitose cutanée bien connue dans les régions tropicales. En Europe, des cas rares ont été décrits chez des patients ayant séjourné dans les zones à risque. Nous rapportons le cas d'un enfant de 4 ans présentant un furoncle au niveau de la cuisse gauche considéré à tort comme un abcès et envoyé aux urgences pour drainage.

[Rational approach and management of the dyspnoeic patient in general medical practice]. / Approche rationnelle et prise en charge du patient dyspnéique en médecine génerale.

Dyspnea represents 3-4 % of consultations at primary care medicine (general medicine, emergency medicine) and is found in 14 % of the interviewed general population. It is defined as an abnormal and uncomfortable breathing and can be classified according to the mode of appearance, the breathing pattern or the rhythm. Different classifications are used to specify the severity of the situation: visual analog scale, functional classification of the New York Heart Association, dyspnea modified scale from the Medical Research Council, ... Rare among young people, dyspnea often hides asthma; more prevalent among seniors, it is often secondary to chronic lung or heart disease. The rational approach is the same in general medicine and in the emergency room. The management starts with an assessment of the severity of the patient's clinical situation, via the early warning score. The critical patient requires to be managed according to the progressive and cyclical ABCDE approach. For non-critical patients, a traditional approach and a reasoned method are needed. In patients suffering from chronic obstructive pulmonary disease (COPD), the use of the Anthonissen criteria allows to orient toward a pulmonary superinfection or another cause of worsening dyspnea (cardiac, ...). In case of suspected pulmonary embolism, the Geneva score and the modified Wells score help to separate low, intermediate or high probability cases of pulmonary embolism. D-dimers have a very good negative predictive value in the low and middle risk group and pulmonary CT angiography applies only to a smaller group of dyspnoeic patients with a high probability of pulmonary embolism. Echocardiography has a prominent role to assess the LV systolic function, the search for pulmonary artery hypertension, the vascular filling state, etc. We speak of psychogenic dyspnea after having excluded the potentially serious pathologies.

[Prospective study of waiting time delays in a university hospital emergency department with a physician triage model]. / Evaluation prospective des délais d'attente dans un service d'urgence d'un hôpital universitaire avec un accueil médicalisé de première ligne.

To measure waiting time delays of patients and to evaluate if the waiting time before the first physician contact is inversely correlated to the illness severity. During the period of 26/02/2007 through 3/03/2007, we prospectively studied the waiting times before the first contact with a physician (WTP) and the length of stay (LS) in 473 patients (0.8% of the annual patient volume) evaluated in our emergency department, which has a physician triage model. The WTP was correlated to a severity score "Clinical Classification of Patients in Emergency (CCPE)". The median WTP was: 48 (22-79) min. (minutes) (median, P25, P75). This time was 33 (14-47), 16 (3-28) and 3 (0-3) min. for patients having a CCPE score of 3, 4 and 5. The median LS was 119 (76-186) min. In conclusion, the waiting times are comparable to those measured in similar studies. The waiting time evaluated according to CCPE is adequate.

Penetrating cardiac injuries in Belgium: 20 years of experience in university hospitals in Brussels.

BACKGROUND: Cardiac wounds remain as highly lethal lesions in which their prognosis depends on the emergency management. OBJECTIVES: The aim of this study is to analyse experiences of cardiac surgeons in different hospitals in Brussels and compare it with the findings in the literature. METHODS: From 1st January 1990 till 1st December 2010, all penetrating cardiac wounds in three Brussels hospitals were retrospectively reviewed. Data recorded included clinical parameters, surgical constatation and outcome. RESULTS: A total of fourteen (12 male/2 female) patients sustained penetrating cardiac injuries. There were thirteen patients (93%) with stabs wounds and, one patient (7%) with gunshot wound. Wound locations are as follows: ten patients (71%) right ventricle, three patients (22%) the pericardium, and one patient (7%) the left ventricle. The hemodynamic status was unstable in nine patients (64%), in-extremis in two patients (14%) and stable in three patients (22%). The mean Abbreviate Injury Score was 4.6 and the mean New Injury Severity Score was 31. Thirteen patients (93%) had operations (11 sternotomie, 2 thoracotomies). Two patients required cardiopulmonary bypass. Three patients (22%) died. CONCLUSION: Penetrating cardiac wounds are relatively rare in Belgium, which is mainly due to stabs and with consequent mortality. The implementation of clear guidelines is necessary to improve survival.

[Implementation of the therapeutic hypothermia recommendation after resuscitated cardiac arrest caused by ventricular fibrillation and tachycardia without pulse: a retrospective study in Saint-Pierre Hospital]. / Etude rétrospective au sein du C.H.U. Saint-Pierre sur l'application de la recommandation d'hypothermie post arrêt cardiaque par fibrillation et tachycardie ventriculaire sans pouls.

INTRODUCTION: Therapeutic hypothermia is an essential step for the neurological protection of comatose individuals after cardiorespiratory arrest (CA) and ventricular fibrillation (VF). The evaluation of the application of the Protocol thereto within the C.H.U. Saint-Pierre (SPH) is the subject of this study. METHOD: Retrospective analyzes of the SPH computerized records from 01/01/2005 to 31/12/2010 whose inclusion criteria are out-of-hospital CA admitted alive to the hospital with VF as initial rythm. Transferred patients or NTBR status are excluded. RESULTS: Of the 72 patients studied, 68% were discharged alive from the hospital, 84% of which has no neurologic sequelae. Hypothermia was used for 44 people, unduly in 5 cases and there were also 5 other cases for which it was needed, but not applied. Hypothermia (32-34 degrees C) was reached in 11 h 23 (+/- 144 min) and lasted an average of 19 h 51 (+/- 249 min). Hypothermic patient survival amounted to 72.4%, including 81% with good neurological outcome. CONCLUSION: The results of the protocol application are superior to those of several other studies. Few errors of inclusion and exclusion are present. The implementing of a common protocol for IC--Emergency Units--EMS to accelerate obtaining the target temperature and improve performance seems beneficial. The creation and implementation of a specific register with patients who had AC and were cooled seem interesting for a better medical follow-up, an assessment of the management and an enhancement of the current knowledge related to this technique.