Pain is the main complaint during an emergency room visit. Whether it is a reason in itself or associated with other symptoms, its management determines the proper course of care. They are also potentially a source of new pain, or added strain for the patient, relatives and caregivers. The nurse organizing the reception area prioritizes the passage of patients according to their potential seriousness. The pain assessment is part of this evaluation, renewed during the time of treatment with anticipated analgesia protocols.

Prise en charge de la douleur à l’accueil des urgences

Objectives The main objective was to assess the relevance of antibiotic prescriptions in the pediatric wards of a regional university hospital in France. Secondary objectives were to assess adequacy of the dose, administration frequency, administration route, treatment duration, adaptation to bacteriological results, and treatment reevaluation. Patients and methods We assessed antibiotic prescriptions in pediatric settings. We included all patients under 18 years of age hospitalized in a pediatric ward who received a computerized prescription for antibiotic treatment between June 1st and June 30th, 2018; 163 clinical cases for 157 patients were analyzed. Patients hospitalized in neonatology, pediatric intensive care unit, and onco-hematology wards were excluded. Results The rate of relevance was 71%. The rates of adequacy for the other criteria were 60% for the dose, 99% for the administration frequency, 98% for the administration route, 72% for treatment duration, 98% for treatment adaptation to microbiological results, and 100% for treatment revaluation. All criteria combined, the overall rate of adequacy was 28%. Conclusions Effort should be made regarding doses and treatment durations. Areas for improvement have been suggested to the wards: standardized prescription protocols, pediatric prescription guide, training of residents, setting up of the operational team in pediatric wards and a second clinical evaluation.

Assessment of antibiotic prescriptions in pediatric care units in a regional university hospital.

A rare lesion, limb dislocation, particularly of the foot, is extremely serious. Its initial mortality is related to hemorrhage. Its morbidity is major due to lack of skin coverage of the bones and infection with functional issues. Management remains poorly codified and unknown, and requires a multidisciplinary medical and paramedical team from pre-hospital to rehabilitation. The initial surgery is ideally conservative to control the infection and cover the persistent skin flaps. An unfavorable evolution imposes amputation, sometimes early. 

[Initial and surgical care of foot ailments].

Prise en charge des plaies en structure d’urgence

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Prise en charge des plaies en structure d’urgence