Ketamine in emergency situations: a molecule with a bright future!

Vanessa Bellemans, Caroline Declerfayt, Jean-Marie Jacques Published in the journal : July 2021 Category : Emergency

Ketamine is an old drug that was first used in the 1960s in anesthesia, displaying quite special properties. This agent is simultaneously hypnotic, amnesic, bronchodilator, antidepressant, and analgesic, while offering a safe profile of use. It preserves airway protection reflexes and respiratory drive, provides hemodynamic stability, and exerts enhanced sympathetic activity. These properties render it ideal for managing critically ill patients. In the emergency room, ketamine plays already a role in intubation support, sedation, and analgesia. Recently, its indications have been extended to the domains of psychiatry and neurology.

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The ‘NPS’- new psychoactive substances - Clinical presentations and managment recommendations

Alexandra Serpe, Mathieu Bonnet, Germain Laubier, Magdalini Polikipis, Marie Belleflamme Published in the journal : May 2021 Category : Emergency

Over the past twenty years, the European drug market has turned out to become more complex because of the emergence of new psychoactive substances (N.P.S). The N.P.S designation refers to new synthetic drugs that are designed to mimic the effects of the so-called standard drugs, such as heroin, cannabis, cocaine, as well as others. Though being similar, the clinical features of N.P.S are inherently more complex to deal with because of their ability to act on different receptor types.

The treatment remains symptomatic owing to the lack of antidotes or quick identification tests. The identification, evaluation, and evolution of the patient at risk of instability primarily guide the treatment.

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D. Douillet, M. Hachez, A-C. Dekeister, M. Thoma, C. Grégoire, L. Levenbergh, R.Cre n, F. Dupriez, B. Rodrigues de Castro, .B. Germeau, C. Steinier, A.Penaloza Published in the journal : April 2021 Category : Emergency

Our Emergency department admits about 75000 patients on average per year, with many of them hospitalized. Emergency medicine is a true transversal specialty, enabling collaboration with colleagues from other departments. The wide range of pathologies, the acute disease phase, as well as the specificity of emergency treatments offers emergency physicians a clear opportunity to embark on research, innovation, and collaboration. The following five subjects illustrate these attractive features of emergency medicine.

• SARS-CoV-2 pandemic initiated a major increase in hospitalizations requirements, in addition to a change in patient flow management. The HOME-CoV rule has been developed to identify a subgroup of low-risk patients that can be treated securely as outpatients.

• The multidisciplinary care of severe trauma is a major challenge in emergency medicine. The potential lesions can indeed be of multiple origins. It is currently admitted that standardized protocols provide substantial benefit in patient care, with a significant impact on patient mortality. Implementation of such procedures in our emergency department has been instrumental for obtaining a supra-regional trauma center certification.

• Pain is a major reason for consultation in emergency departments. Indeed, pain is a true concern for individual patients, as much as for mass emergencies and disasters. Methoxyfluran (Penthrox®), which is an old and almost forgotten drug, has recently undergone new studies that have been published in literature.

• Clinical ultrasound (CUS) is carried out during the clinical examination, which substantially differs from the ultrasound performed in radiology departments. Evidence supports CUS use by emergency physicians at the patient’s bedside either to guide a procedure, help establish a differential diagnosis, select the complementary examinations of choice, or to guide treatments. All these procedures require the building up of a validated curriculum meeting international recommendations.

• Recent studies focused on pulmonary embolism (PE) have explored methods designed to reduce the number of computer tomography (CT) scans required. Given that among patients suspected of exhibiting PE, the prevalence of PE has significantly decreased, most CT examinations could thus be avoided. The 4-level pulmonary embolism clinical probability score (4PEPS) score integrates into a unique score a different method of clinical probability (CP) assessment, proposing a diagnostic strategy based on four levels of CP, resulting in a substantial reduction in imaging testing for patients with suspected PE.

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Acute hepatitis due to nasal cocaine use: clinical case report and literature review

Barbara Gauchet (1), Véronique Gerard (2), Hadrien Fourneau (3) Published in the journal : January 2021 Category : Emergency

We present the case report of a 28-year-old man admitted to the emergency department for acute hepatitis due to nasal cocaine use. Cocaine abuse is associated with a variety of acute medical complications. Acute hepatitis without other systemic disorders is a rare condition that may occur following cocaine use.

Based on a systematic review of the literature, this report seeks to discuss the clinical, biological, and histopathological features of this disease and its evolution, too. The clinical practice guidelines for managing acute hepatitis due to cocaine use will be discussed, as well.

This case provides us the opportunity to remember and explore the differential diagnosis of acute hepatitis and the usefulness of a precise anamnesis.

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Usefulness of S100β protein for managing minor head trauma in the emergency service

Flore Tuyumbu MD (1), Andréa Penaloza MD, PhD (2), Said Hachimi-Idrissi MD, PhD (3) Published in the journal : June 2018 Category : Emergency

Over the last decades, the use of biomarkers in emergency medicine has considerably increased. While the P S100β protein has been considered as a neurological prognostic factor following cardiac arrest or stroke occurrence, it is principally in the minor head trauma management that the P S100β seems to be of interest. Studies have highlighted its usefulness for excluding neurological lesions, without performing brain computed tomography (CT), and this, with a good sensitivity close to 100% (CI: 50 to 100%). The P S100β analysis could be particularly helpful for clinicians in cases where the patient's neurological examination proves unreliable.

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Intranasal drug delivery in emergency medicine

J.-M. Jacques Published in the journal : April 2016 Category : Emergency

Whereas intranasal (IN) drug delivery has been used for many years, this administration route has not gained much interest in Belgium. IN drug delivery is painless, easy, and quick, thus proving attractive in emergency settings, especially in pediatric patients. While achieving an efficacy comparable to that of intravenous administration, the IN route is an interesting new alternative for emergency doctors, who can use it to induce opioid analgesia, reach optimal procedural sedation with midazolam, stop epileptic seizures with benzodiazepines, or antagonize morphine overdosage with naloxone.

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