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

Summary :

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.