[Abdominal wall pain : the « anterior cutaneous nerve entrapment syndrom ¼]. / Douleurs abdominales d'origine pariétale : syndrome de compressionde nerf cutané antérieur.

Abdominal wall pain is a poorly recognized clinical problem and ofently misdiagnosed. It results in inappropriate diagnostic testing, unsatisfactory treatments and considerable costs. However, chronic abdominal wall pain can be easily diagnosed by a precise physical examination and can be rapidly and efficiently treated. Awareness of knowing criteria of the diagnosis is important but their validity needs to be evaluated in additional studies.

Les douleurs abdominales d'origine pariétale sont peu connues et souvent sous-diagnostiquées. De fait, beaucoup d'examens paracliniques sont effectués inutilement. Les coûts de prise en charge sont importants et en l'absence d'un traitement adapté, nous n'arrivons pas à soulager nos patients. Une origine pariétale est pourtant facilement diagnostiquée par un examen clinique ciblé et le traitement est rapide, efficace et peu coûteux. Des études à plus large échelle sont actuellement en cours mais il n'existe pas encore d'algorithme décisionnel validé. De par sa prévalence relativement élevée, la connaissance de ce syndrome reste cependant primordiale.

[Healthcare professionals dealing with burnout: risk factors and preventive measures]. / Les professionnels de la santé face au burnout. Facteurs de risque et mesures preventives.

Although sometimes called "disease of the century", the burnout doesn't inspire a lot of prevention, and is still a taboo, for most of people suffering of this malaise. The healthcare professionals represent a risky population and most of them are not aware of it. Unfortunately existing preventive measures are still badly known. Nevertheless it seems necessary to try to prevent if not slow down the development of this disease before it leads to excessive damages for our already suffering society... Talking about this pathology is quite easy but it is much more difficult than generally thought to admit being personally touched and to look for appropriate help.

Awareness of HIV testing guidelines is low among Swiss emergency doctors: a survey of five teaching hospitals in French-speaking Switzerland.

BACKGROUND: In Switzerland, 30% of HIV-infected individuals are diagnosed late. To optimize HIV testing, the Swiss Federal Office of Public Health (FOPH) updated 'Provider Induced Counseling and Testing' (PICT) recommendations in 2010. These permit doctors to test patients if HIV infection is suspected, without explicit consent or pre-test counseling; patients should nonetheless be informed that testing will be performed. We examined awareness of these updated recommendations among emergency department (ED) doctors. METHODS: We conducted a questionnaire-based survey among 167 ED doctors at five teaching hospitals in French-Speaking Switzerland between 1(st) May and 31(st) July 2011. For 25 clinical scenarios, participants had to state whether HIV testing was indicated or whether patient consent or pre-test counseling was required. We asked how many HIV tests participants had requested in the previous month, and whether they were aware of the FOPH testing recommendations. RESULTS: 144/167 doctors (88%) returned the questionnaire. Median postgraduate experience was 6.5 years (interquartile range [IQR] 3; 12). Mean percentage of correct answers was 59 ± 11%, senior doctors scoring higher (P=0.001). Lowest-scoring questions pertained to acute HIV infection and scenarios where patient consent was not required. Median number of test requests was 1 (IQR 0-2, range 0-10). Only 26/144 (18%) of participants were aware of the updated FOPH recommendations. Those aware had higher scores (P=0.001) but did not perform more HIV tests. CONCLUSIONS: Swiss ED doctors are not aware of the national HIV testing recommendations and rarely perform HIV tests. Improved recommendation dissemination and adherence is required if ED doctors are to contribute to earlier HIV diagnoses.

[When should a patient with malaise be referred to the emergency ward?]. / Quand référer aux urgences un patient présentant un malaise?

General physicians (GPs) and emergency doctors are regularly called upon to deal with cases of "malaise" or sudden unforeseen feelings of debility. As highly disparaged as this designation may be, it remains commonly used in everyday life, enabling patients to express a general sensation of ill-being, accompanied by various non-specific symptoms. The lack of a preliminary case history and clinical analysis makes difficult to swiftly determine the severity of the situation, let alone its etiology. GPs are expected to rapidly detect any possibly serious risk factors; the decision to either hospitalize the patient or allow him to return home, is in their hands. The following article sets forth algorithms to assist with the diagnostic process and general handling of such cases.

[Public access defibrillation]. / Ombres et lumières de l'accès public a la défibrillation.

Placement of automated external defibrillators (AED) in public facilities and training of the lay persons in basic life support-defibrillation (BLS-D) was recommended by the American Heart Association for the treatment of out-of-hospital cardiac arrest (OHCA). Immediate use of AED result in increase of survival to hospital discharge. Many observation and much less randomized trials describe clinical efficacy of this approach. However, "negative" trials have also been published and some recent data suggest that public access defibrillation (PAD) will have a minimal impact on population survival. In this article various PAD strategies were briefly reviewed. In our opinion installation of AED in public places should be based on the long-term study of local OHCA demography and preceded by widespread BLS training of lay population.

[Patient waiting time at the Medical and Surgical Emergency Center at the Hôpital des Cadolles: a descriptive study]. / Enquête sur tes délais d'attente au Centre médico-chirurgical d'urgences, Hôpital des Cadolles, Neuchâtel.

Analyzing how much time patient are waiting in the Medical and Surgical Emergency Center (Centre médico-chirurgical des urgences, CMCU) at the Hôpital des Cadolles (Neuchâtel, Switzerland) before discharge, over a 80 days period found that overall, patients spent on average 2 h 26 in the CMCU. There was a difference between hospitalized patients (3 h 16) and discharged patients (1 h 48). The time from first encounter with a health care provider until discharge or admission was 1 h 42 on average. Again, this time was longer for hospitalized (2 h 15 versus 1 h 17 for ambulatory patients). The majority of patients (76%) were assessed by a nurse or a physician within 5 minutes, while the other 24% of patients had to wait 15 minutes on average. Specifically, 26% of patients were seen by a physician within 5 minutes, while the other 74% had to wait 26 minutes on average.

[Thrombolysis of acute ischemic cerebral vascular accident: roles of the physician and the peripheral hospital]. / Thrombolyse de l'accident vasculaire cérébral ischémique aigu: rôles du praticien et de l'hôpital périphérique.

Thrombolysis administered intravenously within 3 hours (or within 6 hours intra-arterially) after symptoms onset improves the functional outcome of acute ischemic stroke patients. In Switzerland this treatment is only performed by specialized centers. At the level of a community hospital or a general practitioner, the management is based on the appropriate selection of patients in whom thrombolysis could be indicated, followed by their immediate transfer to a reference medical center. Because of the very short therapeutic window, specific criteria have to be used. We present the guidelines of Les Cadolles Hospital in Neuchâtel established in collaboration with the Department of Neurology of the University Hospital of Lausanne and a retrospective analysis of emergency admissions for suspected stroke at Les Cadolles between January 1st 2001 and December 31st 2002.

[The outcome of "thoracic pains" in pre-hospital emergency: role of the physician of the SMUR in the triage and conveyance of patients]. / Le devenir des "douleurs thoraciques" en urgence pré-hospitalière: rôle du médecin du SMUR dans le tri et l'acheminement des patients.

The retrospective analysis of SMUR (Service Mobile Urgences Réanimation) activity in Neuchâtel from 2000 to 2001 shows that 11% of the 1250 prehospital interventions were due to "chest pain". Based upon the NACA gravity scale, a potentially serious cardiac disease was present in more than 75% of the cases. 64% of the patients were admitted to the ICU and 16% were directly transferred to an interventional cardiologic center. 63% of all "chest pain" patients underwent an invasive cardiologic intervention (thrombolysis, PTCA, coronary bypass). Rapid prehospital management including a professional emergency team, such as SMUR, may contribute to a better outcome of these patients exposed to acute and sometimes fatal complications.

[Thrombolysis or primary PCI: the gold standard in the management of acute myocardial infarction in 2003?]. / Thrombolyse ou PCI primaire: le "gold-standard" dans la prise en charge de l'infarctus aigu du myocarde en 2003?

Several studies published recently show the superiority of a primary percutaneous coronary intervention (I degree PCI) on thrombolysis in the treatment of acute myocardial infarction. This holds true even if PCI is delayed by 2 or 3 hours due to the secondary transfer to a hospital disposing of a cath lab. The advantage consists in a significant decrease in the number of secondary ischemia, recurrent myocardial infarction, hemorrhagic stroke and mortality. We retrospectively analysed the patients admitted in our hospital during 2001 with acute myocardial infarction and criteria for thrombolysis. A third of these patients underwent I degree PCI in a reference center, two thirds underwent thrombolysis in our hospital; 87% of thrombolysed patients underwent secondary PCI during the same hospital stay; in all patients (except one) coronary angiography was completed by a percutaneous (25/30) or surgical (4/30) revascularisation. Given the data in the recent literature and our experience, we consider that I degree PCI has to be favored over thrombolysis for most of the patients presenting to our hospital with acute myocardial infarction.

["Extensive" toxicologic research in emergencies: a luxury or a necessity?]. / Recherche toxicologique "large" aux urgences: luxe ou nécessité?

The "undiscriminate" toxicological screening is a tool of potentially extraordinary help, allowing not only the identification of unknown and/or presumed substances in the blood or urine, but also enabling to define, the role of toxic products in a given clinical situation. In order to determine the real utility of this screening, we carried out a retrospective analysis covering the totality of these requests in the emergency unit of our hospital over a period of six months. 74 cases were collected and divided into 3 different categories (necessary, optional and useless). Overall, we found that only 28% of the requests were justified.

[Health care organization at the time of a mass event. The example of EXPO 02--Neuchatel]. / Organisation sanitaire lors d'une manifestation de masse. Exemple d'EXPO 02--Neuchâtel.

The last National Exhibition "EXPO 02" took place in Switzerland in 2002. More than 10 million people visited in within 159 days. The medical service and the "first aid" structures took pattern from other similar events in Switzerland or abroad. EXPO 02 was held on 4 sites. Our experience turned out interesting and somewhat different from the others sites because of the setting up of a "triage and coordination area" in the site of Neuchâtel.