Panorama of Emergency Medicine <p>Panorama of Emergency Medicine (PoEM) journal is an interdisciplinary peer-reviewed open access scientific journal, with an access to Cochrane summary. The journal is owned by <a href="" target="_blank" rel="noopener">New Health Concept (NHC)</a>, a company that provides consultancy, training and publication services related to healthcare. PoEM publishes continuously and is freely available for readers and researchers.</p> en-US Panorama of Emergency Medicine Lemierre Syndrome in a Pediatric Patient with Nephrotic Syndrome: a Case Report <p>Lemierre syndrome is a rare thrombotic complication of head and neck infections. Nephrotic syndrome is sometimes treated by immunosuppressive medications that can present with severe infections without a fever. The association of the two diseases is extremely rare.</p> <p>We report the first case, to our knowledge, of Lemierre syndrome in an eleven-year-old patient with nephrotic syndrome on Tacrolimus.</p> <p>A patient with nephrotic syndrome is at higher risk for all kinds of thrombotic events. Also, being on immunosuppressive therapy can lead to late presentation and the absence of fever. A low level of suspicion in those patients can lead to timely diagnosis and early treatment.</p> Chady El Tawil Anwar Alabdulraheem Keira Kilmartin Jade Seguin Copyright (c) 2023 Chady El Tawil, Anwar Alabdulraheem, Keira Kilmartin, Jade Seguin 2023-04-27 2023-04-27 1 1 Efficiency and relevance of post-exposure prophylaxis prescription by emergency physicians: a monocentric retrospective study <p><strong><u>Abstract </u></strong></p> <p><strong>Background:</strong> Preventing infection with HIV remains a major public health challenge. Exposed persons are offered support and quick access to the post-exposure prophylaxis (PEP) by hospital emergency services. To investigate the accuracy of the prescription of emergency PEP for patients with sexual fluid exposure in a French emergency department (ED) by comparing data in medical files and actual prescriptions.</p> <p><strong>Methods:</strong> We retrospectively collected data for patients consulting for sexual exposure in a single Parisian ED from 2015 to 2016. For each patient, researchers independently checked whether the emergency physician prescribed PEP according to French guidelines. Our primary outcome was the appropriateness of the emergency PEP prescription after sexual fluid exposure. We calculated the Cohen weighted kappa coefficient with its 95% confidence interval (CI) for determining the agreement in indication for PEP.</p> <p><strong>Results:</strong> We included 346 patients in the analysis. Half of the patients were men who had sex with men (n=178). The most frequent sexual exposure was anal insertive or receptive (n=177; 51%). PEP was prescribed in 94% of cases (n=328). In 33 cases (10%) the indication for PEP was not clear, but PEP was prescribed in 17 cases (52%). The Kappa value for determining the indication for PEP was 0.55 (95% confidence interval 0.36-0.74), indicating poor agreement for prescription. The agreement was lowest for men who had sex with men: 0.29 (0.05-0.53).</p> <p><strong>Conclusion:</strong> Strategies are needed to improve the relevance of the prescription of PEP in French EDs to avoid the excess secondary effects and cost.</p> Xavier Eyer Youri Yordanoff Dominique Pateron Patrick Plaisance Anthony Chauvin Copyright (c) 2023 Xavier Eyer, Youri Yordanoff, Dominique Pateron, Patrick Plaisance, Anthony Chauvin 2023-07-26 2023-07-26 1 1 Association between septic shock prehospital hemodynamic parameters improvement and 28-day mortality <p style="font-weight: 400;"><em>Objective:</em></p> <p style="font-weight: 400;">The early hemodynamic optimization of septic shock patients is a cornerstone of care to hope for a better outcome, e.g., mortality decrease. However, in the prehospital setting, hemodynamic evaluation is restricted to micro and macrocirculatory clinical parameters.</p> <p style="font-weight: 400;">This study aims to assess the relationship between micro and macrocirculatory hemodynamic parameters improvement and 30-days mortality among septic shock patients being taken care of for by a mobile intensive care unit (mICU) in the prehospital setting.</p> <p style="font-weight: 400;"><em>Methods:</em> We performed a retrospective multicenter study, from January 2015 to November 2019 including septic shock patients requiring pre-hospital mICU intervention.</p> <p style="font-weight: 400;"><em>Results:</em> Three hundred thirty-seven patients were analyzed. The mean age was 69 ± 15-years-old and 226 of which 67% were male patients. One hundred thirty-six patients (40%) had previous hypertension. Pulmonary infection was the main cause of septic shock (46%) and 30-days mortality reached 30%.</p> <p style="font-weight: 400;">After propensity score analysis, for the macrocirculation: when systolic blood pressure increased by at least 30mmHg the odd ratio (OR) for 30-days mortality was 0.77 [0.65-0.84], when diastolic blood pressure increased by at least 5mmHg, the OR for 30-days mortality was 0.95 [0.88-0.99], when mean blood pressure increased by at least 30%, the OR for 30-days mortality was 0.88 [0.77-0.92] and when the heart rate decreased by at least 30 bpm, the OR for 30-days mortality was 0.62 [0.55-0.76]. For microcirculation, when the mottling score decreased by at least 2 points, the OR for 30-days mortality was 0.83 [0.75-0.91].</p> <p style="font-weight: 400;"><em>Conclusion:</em> In this study, we report that prehospital improvement in micro and macrocirculatory parameters are associated with 30-days mortality rate decrease<span style="text-decoration: line-through;">.</span></p> Romain Jouffroy Basile Gilbert Papa Gueye Léa Thomas Emmanuel Bloch Laine Patrick Ecollan Josiane Boularan Vincent Bounes Benoit Vivien Copyright (c) 2023 Romain Jouffroy, Basile Gilbert, Papa Gueye, Léa Thomas, Emmanuel Bloch Laine, Patrick Ecollan, Josiane Boularan, Vincent Bounes, Benoit Vivien 2023-05-14 2023-05-14 1 1 Risk Factors for Return Visits to the Pediatric Emergency Department: Systematic Search and Review <p><strong>Objectives</strong></p> <p>Return visits (RVs) to the emergency department (ED) has always been a major concern. RVs to the emergency department are a big burden on the healthcare system as its cost is higher than the cost of the initial visit. This review was performed to identify factors associated with risk of RVs to the pediatric ED.</p> <p>&nbsp;</p> <p><strong>Methods and Analysis</strong></p> <p>One researcher searched Medline, Embase, Cochrane Library and Web of Science. Studies were identified by using MeSH and keywords and included RVs to the pediatric ED up to 1 year a primary outcome. All studies were screened by two independent reviewers for eligibility and in case of disagreement, a meeting was held to discuss the problematic studies and a consensus was achieved.</p> <p>&nbsp;</p> <p><strong>Results</strong></p> <p>The search identified 539 reports from which 28 articles were included. Data was then extracted from the included studies according to a preset format. The exposures were grouped in 3 different groups: very probable, possible, and less likely.</p> <p>As a result, young age, language barrier and high acuity were identified as very probable risk factors. Having a public insurance or with low income, patients with comorbidities and patients who had multiple previous ED visits were found to be possible risk factors for return visits.</p> <p>&nbsp;</p> <p><strong>Conclusion</strong></p> <p>Young age, high acuity and language barrier among others are risk factors for return visits to the pediatric ED. Physicians should be aware of these factors and have a low threshold for admission or a good discharge plan for patients with one or more factors.</p> Chady El Tawil Imane Chedid Amy Bergeron Isabelle Gagnon Ilana Greenstone Copyright (c) 2023 Chady El Tawil, Imane Chedid, Amy Bergeron, Isabelle Gagnon, Ilana Greenstone 2023-05-08 2023-05-08 1 1 Heart rate, a poor predictor of Pulmonary Embolism <p><strong>Objective:</strong> To determine if there is a significant difference in vital signs between patients with confirmed and excluded pulmonary embolism (PE) throughout their Emergency Department presentation.</p> <p><strong>Methods:</strong> We conducted a retrospective cohort study with patients presenting with suspected PE to Monash Health Emergency Departments between July 2014 and July 2019. Vital signs were compared between patients with confirmed or excluded PE as determined by imaging (CTPA or VQ). Vital signs were compared at three unique data points: initial, minimum, and maximum values.</p> <p><strong>Results:</strong> 3549 patients met inclusion criteria, 922 with confirmed PE and 2627 with excluded PE based on CTPA or VQ. Patients with PE had significant elevations in mean respiratory rates, systolic blood pressures and reduced oxygen saturations compared to patients without PE. Heart rate was not significantly different at initial and maximum datapoints.</p> <p><strong>Conclusion:</strong> Vital signs were demonstrated to be poor predictors of acute PE. Receiver operating characteristic curve analysis suggests that heart rate has poor discriminative power<strong>.</strong> AUC values for heart rate were: 0.516 (initial), 0.549 (maximum) and 0.519 (minimum). Furthermore<em>, </em>95% of patients with confirmed PE did not exceed heart rates of 100 BPM during presentation to Emergency. The utility of elevated heart rate and other vital signs in predicting PE were not substantiated in this study.</p> Melinda Fernando Faris Gondal Alastair Meyer Pourya Pouryaha Copyright (c) 2023 Pourya Pouryaha, Melinda Fernando, Faris Gondal, Alastair Meyer 2023-03-22 2023-03-22 1 1