The cost of saving lives: Complications arising from prehospital tourniquet application.
Rittblat M, Gendler S, Tsur N, Radomislensky I, Ziv A, Bodas M. | Acad Emerg Med. 2025 May;32(5):532-541
DOI: https://doi.org/10.1111/acem.15070  | Télécharger l'article au format  
Keywords: Aucun

ORIGINAL ARTICLE

Introduction : Uncontrolled hemorrhage is a leading cause of preventable death in trauma. Tourniquets (TQs) are commonly used to control bleeding in the prehospital setting, although their application is associated with risks. Therefore, this study aimed to identify complications arising from TQ use and to examine contributing risk factors.

Méthode : This retrospective observational study reviewed the medical records of adult trauma casualties (>18 years) hospitalized at Chaim Sheba Medical Center (SMC) between 2010 and 2020 who had a TQ applied in the prehospital setting. The primary outcome was the rate and type of complications. Logistic regression analyses identified risk factors using demographic, injury, and clinical data.

Résultats : From 2010 to 2020, a total of 84 trauma casualties with documented prehospital TQ application were hospitalized at SMC. Of these, 20 (23.81%) experienced TQ-related complications, including local infection, compartment syndrome, and thromboembolism. The average TQ application time was 44.2 min, with no significant difference between those with and without complications. However, significant differences were noted in the mechanism of injury (MOI), wound contamination levels, indications for TQ application, and initial blood test results (p < 0.05). Logistic regression analyses revealed length of stay (LOS) and injuries from falls were significantly associated with the development of complications.

Conclusion : This study found that a significant trauma in prehospital settings requiring TQ application is associated with a high rate of complications. Early complications, including local infections and compartment syndrome, were more frequent, whereas late complications like thromboembolism and muscle atrophy were less common. The findings suggest that factors such as the MOI and wound contamination may contribute to these complications, yet after applying multivariate regression, LOS and falls were the only variables found to be significantly associated with the development of complications. These findings underscore the need for further research comparing casualties with and without TQ application.

Conclusion (proposition de traduction) : Cette étude a montré qu'un traumatisme important en milieu préhospitalier nécessitant la pose d'un garrot est associé à un taux élevé de complications. Les complications précoces, notamment les infections locales et le syndrome des loges, étaient plus fréquentes, tandis que les complications tardives, comme la thrombophlébite et l'atrophie musculaire, étaient moins courantes. Les résultats suggèrent que des facteurs tels que le mécanisme de la blessure et la contamination de la plaie peuvent contribuer à ces complications, mais après avoir appliqué une régression multivariée, la durée du séjour et les chutes ont été les seules variables à être significativement associées au développement de complications. Ces résultats soulignent la nécessité de poursuivre les recherches en comparant les blessés avec et sans garrot.

Commentaire :  Schéma corporel montrant la zone anatomique et les proportions de l'application du garrot dans la cohorte étudiée.

Benhamed A, Miossec A, Bonnet M, Tazarourte K, Emond M.. | Ann Fr Med Urgence. 2025 mai-juin:15(3):161-169
DOI: https://www.jle.com/10.1684/afmu.2025.0627
Keywords: Luxation de l’épaule ; Prise de décision clinique

MISE AU POINT

Editorial : La luxation de l’épaule est un motif de consultation fréquent aux urgences, principalement chez les hommes jeunes, mais également chez les femmes plus âgées. La luxation antéro-inférieure est la forme la plus fréquente, souvent due à un traumatisme indirect porté à un membre en abduction, rotation externe et en extension. Les récidives sont fréquentes, avec des facteurs de risque incluant l’âge, le sexe masculin et la présence de lésions associées. Le diagnostic est avant tout clinique et sur la base de la règle de décision clinique Fresno-Québec il semble possible de ne pas avoir recours de façon systématique à une radiographie avant la manœuvre de réduction afin d’éliminer une fracture associée. Cependant une radiographie post-réduction reste nécessaire. La performance de l’échographie au chevet pour confirmer le diagnostic et la bonne réduction de l’épaule est excellente. Plusieurs techniques de réduction existent, cependant aucune ne semble supérieure. Un facteur de risque majeur d’échec de la réduction est le retard dans le traitement. Certaines techniques pourraient avoir l’avantage de ne pas nécessiter de sédation procédurale. L’anesthésie intra-articulaire semble être une alternative efficace et sécuritaire qui pourrait être privilégiée en cas de contre-indication à une sédation procédurale. Après réduction, il est recommandé d’immobiliser l’épaule pour une durée de 2 à 4 semaines chez le patient jeune et de 1 à 2 semaines chez le patient plus âgé afin d’éviter le développement d’une raideur articulaire. Enfin, les patients devraient être systématiquement référés en chirurgie orthopédique et particulièrement ceux présentant des complications ou des facteurs de risque de récidive.

Conclusion (proposition de traduction) : La luxation de l’épaule est une pathologie fréquemment rencontrée aux urgences, nécessitant une prise en charge rapide et appropriée. Le diagnostic est avant tout clinique et une radiographie n’est probablement pas nécessaire en cas d’épisode récurrent atraumatique peu importe l’âge du patient, ou après un traumatisme à faible énergie chez un patient jeune. Un examen neurovasculaire consigné dans le dossier médical est indispensable avant et après réduction, dont le succès sera objectivé par des radiographies de contrôle. Les techniques de réduction et les options d’analgésie sont variées et doivent être choisies avec soins et adaptées à chaque patient.

Managing Analgesia for Hip Fractures.
Long B, Shalaby M, Gottlieb M. | Ann Emerg Med. 2025 May 8:S0196-0644(25)00193-3
DOI: https://doi.org/10.1016/j.annemergmed.2025.04.007
Keywords: Aucun

PAIN MANAGEMENT AND SEDATION/EXPERT CLINICAL MANAGEMENT

Editorial : Fractures of the femoral neck or head (commonly referred to as hip fractures) account for 87% of all femur fractures. There are approximately 340,000 hip fractures annually in the United States. The vast majority of these fractures occur in patients older than 65 years, and more than 75% of hip fractures occur in women. Hip fractures are associated with higher mortality at one year than any other long bone fracture. They are often managed primarily with opioids, which carry a high risk of side effects.

Conclusion : In this article, we will discuss the approach to hip fracture management with a focus on the use of multimodal analgesia and regional anesthesia. This paper does not intend to be a comprehensive review of all aspects pertaining to hip fractures but rather seeks to provide the key tenets of management based on the current literature and years of practice.

Conclusion (proposition de traduction) : Dans cet article, nous discuterons de l'approche de la prise en charge des fractures de la hanche en mettant l'accent sur l'utilisation de l'analgésie multimodale et de l'anesthésie régionale. Cet article n'a pas l'intention d'être une revue complète de tous les aspects relatifs aux fractures de la hanche, mais cherche plutôt à fournir les principes clés de la prise en charge sur la base de la littérature actuelle et d'années de pratique.

Should we apply the pressure in preoxygenation?.
Fisk P, Lam W, Yang J, Nickel C. | CJEM. 2025 May 21
DOI: https://doi.org/10.1007/s43678-025-00936-z  | Télécharger l'article au format  
Keywords: Aucun

Need to Know: CJEM Journal Club

Introduction : Hypoxemia is common in endotracheal intubation of the critically ill patient and is associated with increased rates of cardiac arrest and death.
To evaluate whether non-invasive positive pressure ventilation (NIV) during preoxygenation reduces the rate of hypoxemia during emergency intubation of critically ill patients compared to oxygen masks.

Méthode : Pragmatic multicentre randomized control trial.
Setting: EDs and 17 ICUs in the USA.
Eligibility criteria: Critically ill patients, > 18 years old, undergoing endotracheal intubation requiring sedation and laryngoscopy who were not previously on NIV prior to intubation, apneic, had an immediate need for intubation and were not high risk of aspiration.
Outcomes: Primary outcome was hypoxemia (Sats < 85%) between induction and 2 min post-intubation. Secondary outcomes: lowest O2 saturation. Exploratory outcomes: cardiac arrest, hypotension or new vasopressor requirement. Safety outcomes: aspiration events.
Intervention: Preoxygenation with NIV compared with O2 mask.

Résultats : 1301 patients enrolled, 645 in NIV group and 656 in the oxygen mask group. 95.5% of the NIV group and 98.8% of the O2 mask group received their assigned preoxygenation method.
In addition, there was greater effect in prevention of hypoxemia among patients with higher body mass index and no significant difference in aspiration events was noted between the two groups.

Conclusion : The results of this study support the use of NIV as the method of preoxygenation to prevent desaturation in the critically ill patient requiring intubation. This in turn, may reduce the rates of cardiac arrest peri intubation without increasing the risk of aspiration. Logistically, this may be limited by accessibility of NIV in all emergency departments. From a physiological perspective, positive pressure ventilation via BVM with PEEP may confer a similar advantage, however, this is yet to be determined.

Conclusion (proposition de traduction) : Les résultats de cette étude soutiennent l'utilisation de la VNI comme méthode de préoxygénation pour prévenir la désaturation chez les patients en état critique nécessitant une intubation. Cela pourrait réduire le taux d'arrêt cardiaque après intubation sans augmenter le risque d'inhalation. D'un point de vue logistique, cela peut être limité par l'accessibilité de la VNI dans tous les services d'urgence. D'un point de vue physiologique, la ventilation à pression positive via une ventilation au BAVU avec un masque avec une PEEP pourrait conférer un avantage similaire, mais cela reste à déterminer.

Commentaire : Société Française d’Anesthésie et Réanimation (SFAR), Société Française de Médecine d’Urgence (SFMU). Intubation en urgence d’un adulte hors bloc opératoire et hors unité des soins critiques. Recommandations Formalisées d’Experts (RFE)  . Mars 2025

New atrial fibrillation guideline: Modify risk, control rhythm, prevent progression.
Campbell LA, Ammon JP, Kombathula R, Muhammad N, Jackson CD. | Cleve Clin J Med. 2025 May 1;92(5):291-296.
DOI: https://doi.org/10.3949/ccjm.92a.24067  | Télécharger l'article au format  
Keywords: Aucun

GUIDELINES TO PRACTICE

Editorial : The latest (2023) guideline on atrial fibrillation from the American College of Cardiology, American Heart Association, American College of Chest Physicians, and Heart Rhythm Society introduces a new staging system for the disease, emphasizes risk-factor modification, prioritizes rhythm control over rate control, and clarifies which patients should be considered for catheter ablation. It also delves deeper than earlier guidelines into calculations of risk of thrombosis when deciding whether to start anticoagulant therapy.

Conclusion : The new guideline will lead to more efforts to prevent atrial fibrillation through aggressive lifestyle and risk- factor modification. There will be a preference for early rhythm control over rate control and for ablation as the first line of treatment in certain groups. Also, the new guidelines will involve using scoring systems beyond CHA2DS2-VASc and frequently assessing stroke and bleeding risk to allow better risk stratification for patients beyond just those considered at high risk.

Conclusion (proposition de traduction) : Cette nouvelle recommandation incitera à redoubler d'efforts pour prévenir la fibrillation auriculaire en adoptant un mode de vie dynamique et en modifiant les facteurs de risque. La préférence sera donnée à un contrôle précoce du rythme plutôt qu'à un contrôle de la fréquence et à l'ablation comme première ligne de traitement dans certains cas. En outre, les nouvelles lignes directrices impliqueront l'utilisation de systèmes de scoring autres que le CHA2DS2-VASc et l'évaluation fréquente du risque d'accident vasculaire cérébral et d'hémorragie afin de permettre une meilleure stratification du risque pour les patients, au-delà de ceux considérés comme à haut risque.

Commentaire : Sellal JM, Hammache N, Echivard M. La fibrillation atriale en 2025 : diagnostic et prise en charge [Atrial fibrillation in 2025: Diagnosis and treatment]. Rev Med Interne. 2025 Mar 12:S0248-8663(25)00078-5  . French

Manual pressure augmentation to enhance defibrillation in cardiac arrest.
Carley E, Carley S. | Emerg Med J. 2025 May 2:emermed-2025-215019
DOI: https://doi.org/10.1136/emermed-2025-215019
Keywords: Cardiopulmonary Resuscitation; Defibrillators; Out-of-Hospital Cardiac Arrest.

Best Evidence Topic reports

Editorial : A shortcut review of the literature was conducted to determine whether manual pressure augmentation improves the outcome from cardiac arrest. A total of nine publications were screened by title and abstract and one study (a case report and literature review) underwent full-text review. A further review of bibliographies of relevant papers found one further relevant study protocol. Details about the author, date of publication, country of publication, patient group studied, study type, relevant outcomes (survival and return of spontaneous circulation rate), results and study limitations were tabulated.

Conclusion : The clinical bottom line is that, in adult patients in ventricular fibrillation or ventricular tachycardia, manual pressure augmentation during defibrillation may reduce impedance. This might improve defibrillation success, but there is insufficient evidence to recommend this without further research.

Conclusion (proposition de traduction) : La conclusion clinique est que, chez les patients adultes en fibrillation ventriculaire ou en tachycardie ventriculaire, l'augmentation manuelle de la pression pendant la défibrillation peut réduire l'impédance. Cela pourrait améliorer le succès de la défibrillation, mais il n'y a pas suffisamment de preuves pour le recommander sans recherches supplémentaires.

Commentaire : Heyer Y, Baumgartner D, Baumgartner C. A Systematic Review of the Transthoracic Impedance during Cardiac Defibrillation. Sensors (Basel). 2022 Apr 6;22(7):2808  .



L’augmentation de pression sur les patchs de défibrillation est suggérée notamment chez l’obèse (également par l’ERC 2021) mais peut provoquer un choc accidentel sur le soignant (une étude en cours est stoppée temporairement pour cette raison).
Pourquoi ne pas revenir aux palettes ? Il reste à confirmer l’amélioration des résultats sur la survie…

In adult patients presenting to ED with severe acute pain, is intranasal ketamine as effective as intravenous opiates for pain reduction?.
Santilal K, Saldanha R. | 2025 May 30:emermed-2025-215080. . 2025 May 30:emermed-2025-215080.
DOI: https://doi.org/10.1136/emermed-2025-215080
Keywords: Emergency Medicine; analgesia; emergency department; pain management.

Best Evidence Topic reports

Editorial : This systematic review assessed whether intranasal (IN) ketamine is as effective as intravenous (IV) opiates for adults presenting to the ED with acute severe pain. EMBASE and Medline were searched, using relevant search terms, identifying four studies relevant to our three-part question. Key findings, as well as study weaknesses, were presented in a table. In summary, our results indicate that IN ketamine provides pain relief comparable to IV morphine in this patient cohort, with a similar side effect profile. However, the generalisability of these findings is limited owing to the lack of uniformity in study methodologies, short-term follow-up, broad exclusion criteria, sampling techniques and small sample sizes. Further studies regarding the role of IN ketamine in this setting would be worthwhile.

Conclusion : Intranasal ketamine provides effective analgesia when compared with intravenous morphine in adult patients presenting with acute severe pain to ED. The side effect profile is largely similar and should be considered in patients in whom intravenous morphine is contraindicated or those who lack intravenous access.

Conclusion (proposition de traduction) : La kétamine intranasale fournit une analgésie efficace par rapport à la morphine intraveineuse chez les patients adultes présentant une douleur aiguë sévère aux urgences. Le profil des effets secondaires est largement similaire et doit être envisagé chez les patients pour lesquels la morphine intraveineuse est contre-indiquée ou ceux qui n'ont pas d'accès intraveineux.

Ten tips for managing caustic ingestion in adult patients.
Walter T, Gosselin S, Deniau B. | Intensive Care Med. 2025 Jun;51(6):1164-1167
DOI: https://doi.org/10.1007/s00134-025-07920-2  | Télécharger l'article au format  
Keywords: Aucun

What’s New in Intensive Care

Editorial : Caustic or corrosive ingestion in adult patient is a rare but potentially life-threatening condition with a mortality of 10% among intensive care unit (ICU) patients. This narrative review outlines ten essential tips for managing patients with caustic ingestion.

Conclusion : (1) Intubate early and look for signs of hollow organ perforation
(2) Do not use activated charcoal, insert nasogastric tube, provoke vomiting or make patient drink
(3) Determine the composition of the product
(4) Carefully check for co-intoxication
(5) Call a referral center to discuss orientation and management
(6) Correct any systemic effect of the caustic substance
(7) Avoid endoscopy-based strategies for early caustic ingestion assessment
(8) Perform a CT scan 6 h post-ingestion to guide surgical decisions
(9) Bronchoscopy is mandatory before surgical treatment
(10) In the absence of surgical treatment, start rehabilitation early

Conclusion (proposition de traduction) : (1) Intubation précoce et recherche de signes de perforation des organes creux
(2) Ne pas utiliser de charbon actif, ne pas insérer de sonde gastrique, ne pas provoquer de vomissements et ne pas faire boire le patient
(3) Déterminer la composition du produit
(4) Vérifier soigneusement l'absence de coïntoxication
(5) Appeler un centre de référence pour discuter de l'orientation et de la prise en charge
(6) Corriger tout effet systémique de la substance caustique
(7) Éviter les stratégies basées sur l'endoscopie pour l'évaluation précoce de l'ingestion de substances caustiques
(8) Réaliser un scanner 6 heures après l'ingestion pour guider les décisions chirurgicales
(9) La bronchoscopie est obligatoire avant le traitement chirurgical
(10) En l'absence de traitement chirurgical, commencer la rééducation rapidement.

Commentaire :  Classement par le World Journal of Emergency Surgery des lésions caustiques de l'estomac et de l'œsophage et résumé des dix conseils pour la prise en charge de l'ingestion de produits caustiques

Real-World Clinical Impact of High-Sensitivity Troponin for Chest Pain Evaluation in the Emergency Department.
Martin JA, Zhang RS, Rhee AJ, Saxena A, Akindutire O, Maqsood MH, Genes N, Gollogly N, Smilowitz NR, Quinones-Camacho A. | J Am Heart Assoc. 2025 May 20;14(10):e039322
DOI: https://doi.org/10.1161/jaha.124.039322  | Télécharger l'article au format  
Keywords: chest pain; emergency department; high‐sensitivity; troponin.

ORIGINAL RESEARCH

Introduction : High-sensitivity cardiac troponin (hs-cTnI) assays can quantify troponin concentrations with low limits of detection, potentially expediting and enhancing myocardial infarction diagnoses. This study investigates the real-world impact of hs-cTnI implementation on operational metrics and downstream cardiac services in patients presenting to the emergency department with chest pain.

Méthode : We conducted a retrospective study of patients who presented to 3 emergency departments for chest pain and in whom ≥1 troponin concentration was measured. We compared outcomes from January 2021 to March 2022 (conventional cardiac troponin I [cTnI]) against outcomes from April 2022 to March 2023 (post-hs-cTnI implementation). The primary outcome was hospital length of stay.

Résultats : The study included 32 076 emergency department patient-visits (17 267 with cTnI, 14 809 with hs-cTnI). Implementation of hs-cTnI was associated with shorter median total length of stay (6.6 versus 6.0 hours, P [lt]0.001), shorter emergency department length of stay (5.5 versus 5.4 hours, P=0.039), and lower admission rates (32.6% versus 38.2%, adjusted odds ratio [aOR], 0.74 [95% CI, 0.69-0.79]; P [lt]0.0001). Hs-cTnI was also associated with lower odds of cardiology consultation (aOR, 0.91 [95% CI, 0.86-0.97]; P=0.004), echocardiography (aOR, 0.86 [95% CI, 0.82-0.91]; P [lt]0.001), stress tests (aOR, 0.74 [95% CI, 0.67-0.81]; P [lt]0.001), and invasive coronary angiography (aOR, 0.77 [95% CI, 0.70-0.83]; P [lt]0.001), but greater odds of computed tomography coronary angiography (aOR, 1.26 [95% CI, 1.01-1.56]; P=0.03) and percutaneous coronary intervention (aOR, 1.40 [95% CI, 1.20-1.63]; P [lt] 0.001) during the index encounter.

Conclusion : Implementation of the hs-cTnI assay was associated with reduced hospital admissions, shorter length of stay, and decreases in most downstream cardiac testing.

Conclusion (proposition de traduction) : La mise en place du dosage de la hs-cTnI a été associée à une réduction du nombre des hospitalisations, à une diminution de la durée du séjour et à une diminution de la plupart des examens cardiaques en aval.

First attempt success with continued versus paused chest compressions during cardiac arrest in the emergency department.
Robinson AE, Driver BE, Prekker ME, Reardon RF, Horton G, Stang JL, Collins JD, Carlson JN. | Resuscitation. 2023 May;186:109726
DOI: https://doi.org/10.1016/j.resuscitation.2023.109726
Keywords: Airway; Airway management; Cardiac arrest; Cardiopulmonary resuscitation.

CLINICAL PAPER

Introduction : Tracheal intubation is associated with interruption in cardiopulmonary resuscitation (CPR). Current knowledge of tracheal intubation during active CPR focuses on the out-of-hospital environment. We aim to describe characteristics of tracheal intubation during active CPR in the emergency department (ED) and determine whether first attempt success was associated with CPR being continued vs paused.

Méthode : We reviewed overhead video from adult ED patients receiving chest compressions at the start of the orotracheal intubation attempt. We recorded procedural detail including method of CPR, whether CPR was continued vs paused, and first attempt intubation success (primary outcome). We performed logistic regression to determine whether continuing CPR was associated with first attempt success.

Résultats : We reviewed 169 instances of tracheal intubation, including 143 patients with continued CPR and 26 patients with paused CPR. Those with paused CPR were more likely to be receiving manual rather than mechanical chest compressions. Video laryngoscopy and bougie use were common. First attempt success was higher in the continued CPR group (87%, 95% CI 81% to 92%) than the interrupted CPR group (65%, 95% CI 44% to 83%, difference 22% [95% CI 3% to 41%]). The multivariable model demonstrated an adjusted odds ratio of 0.67 (95% CI 0.17 to 2.60) for first attempt intubation success when CPR was interrupted vs continued.

Conclusion : It was common to continue CPR during tracheal intubation, with success comparable to that achieved in patients without cardiac arrest. It is reasonable to attempt tracheal intubation without interrupting CPR, pausing only if necessary.

Conclusion (proposition de traduction) : Il était courant de poursuivre la RCP pendant l'intubation trachéale, avec un succès comparable à celui obtenu chez les patients n'ayant pas subi d'arrêt cardiaque. Il est raisonnable de tenter une intubation trachéale sans interrompre la RCP, en ne s'arrêtant que si nécessaire.

Intravenous vs intraosseous administration of drugs for out of hospital cardiac arrest: A systematic review and meta-analysis.
Saad M, Sohail MU, Waqas SA, Ansari I, Gupta A, Jain H, Ahmed R. | Am J Emerg Med. 2025 May;91:100-103
DOI: https://doi.org/10.1016/j.ajem.2025.02.029  | Télécharger l'article au format  
Keywords: Drug administration; Emergency medicine; Intraosseous access; Intravenous access; Out-of-hospital cardiac arrest; Randomized controlled trials; Survival outcomes; Vascular access; meta-analysis.

Article

Introduction : Out-of-hospital cardiac arrest (OHCA) is a leading cause of global mortality. Timely drug administration via vascular access is critical, with intravenous (IV) and intraosseous (IO) routes being the primary options. Current guidelines prefer IV access but recommend IO when IV access is delayed. This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the clinical effectiveness of IO compared to IV access in adults with OHCA.

Méthode : A comprehensive search of PubMed, Scopus, and Cochrane databases through November 2024 identified RCTs comparing IO and IV drug administration in OHCA patients aged ≥18 years. Outcomes included 30-day survival, sustained return of spontaneous circulation (ROSC), survival to hospital discharge, and survival with favorable neurological outcomes. Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated using a random-effects model.

Résultats : Three RCTs comprising 9293 patients were included. No significant differences were found between IO and IV routes for 30-day survival (OR: 1.00, 95 % CI: 0.76-1.34, p = 0.98), sustained ROSC (OR: 1.08, 95 % CI: 0.97-1.21, p = 0.18), survival to hospital discharge (OR: 1.03, 95 % CI: 0.84-1.25, p = 0.80), or favorable neurological outcomes (OR: 0.93, 95 % CI: 0.77-1.13, p = 0.49).

Conclusion : IV and IO access routes demonstrated comparable outcomes for survival and neurological function in OHCA. These findings support the flexibility to prioritize the most practical route in emergency settings, particularly when IV access is delayed or challenging. Further research should explore patient-level outcomes and health economic implications.

Conclusion (proposition de traduction) : Les voies d'accès IV et IO ont donné des résultats comparables en termes de survie et de fonction neurologique lors d'un arrêt cardiaque extrahospitalier. Ces résultats confirment la nécessité de donner la priorité à la voie la plus pratique dans les situations d'urgence, en particulier lorsque l'accès IV est retardé ou difficile. Des recherches supplémentaires devraient explorer les résultats au niveau du patient et les implications économiques pour la santé.

Commentaire : Nouvelle pierre au débat sur la voie d’administration des médicaments dans l’arrêt cardiaque depuis les recommandations de 2021. Le débat est loin d’être tranché. Il est à noter qu’une forte hétérogénéité (I2 > 50 %) a été observée pour la survie à 30 jours.
Pour la voie intra-osseuse, l’abord humérale semble bien être à privilégier, ce qui n’a pas été abordé ici. Il manque une grande étude multicentrique pour répondre définitivement à la question.
Enfin, la voie IM pour la première dose d’adrénaline vient de s’inviter au débat !

Hyperangulated video laryngoscopy in the emergency department: An analysis of errors and factors leading to prolonged apnea time.
Bryan A, Feltes J, Sweetser PW, Winsten S, Hunter I, Yamane D. | Am J Emerg Med. 2025 May 19;95:153-158
DOI: https://doi.org/10.1016/j.ajem.2025.05.026
Keywords: Intubation; Quality improvement; Video laryngoscopy.

Article

Introduction : Video laryngoscopy (VL) is a widely utilized method for endotracheal intubation that both increases first pass success and reduces esophageal intubations. Use of VL in a teaching environment allows for real-time feedback for new learners and creates an opportunity for education and quality improvement. There is limited research on the difficulties that VL users face during intubation attempts. This study aims to explore the errors practitioners make while using hyperangulated video laryngoscopes and investigate how the errors affect intubation time.

Méthode : We conducted a retrospective observational study of 101 intubations performed using hyperangulated VL at a single academic hospital. All intubations were performed by Emergency Medicine residents with supervision from attending physicians. Videos were reviewed by two persons and discrepancies were resolved by a third party. The variables included were grade of view, intubation times, and multiple noted errors of intubation consistent with those previously studied.

Résultats : First pass success occurred in 84.9 % of intubations; of those, the median time (IQR) to obtain a view of the vocal cords was 7 (5-11) seconds and the median time for tube delivery was 26 (20.75-43) seconds. 67.0 % of successful intubations reviewed contained at least one error. 43.8 % of intubations had errors in blade placement. The second most frequent error was difficulty with tube delivery occurring in 39.6 % of intubations. Inappropriate use of suction was another studied error; unnecessary suctioning accounted for 35.7 % of all cases where suction was used, and suction was not performed when indicated in 9.0 % of cases.

Conclusion : Correct blade placement and anterior delivery of the endotracheal tube are the most challenging steps of the intubation process for our residents. Future educational sessions for novice intubators can focus on techniques such as proper patient positioning, endotracheal tube and stylet molding, and hand positioning for delivering the endotracheal tube (ETT) to help mitigate these errors.

Conclusion (proposition de traduction) : Le placement correct de la lame et l'introduction antérieure de la sonde endotrachéale sont les étapes les plus difficiles du processus d'intubation pour nos étudiants. Les futures sessions de formation pour les débutants en intubation peuvent se concentrer sur des techniques telles que le positionnement correct du patient, le moulage de la sonde endotrachéale et du stylet, et le positionnement des mains pour l'introduction de la sonde endotrachéale (ETT) afin d'aider à réduire ces erreurs.

Finger thoracostomy: Significant risks and unproven benefits in prehospital settings.
Mozer-Glassberg Y, Radomislensky I, Benov A, Almog O. | Transfusion. 2025 May;65 Suppl 1(Suppl 1):S98-S102
DOI: https://doi.org/10.1111/trf.18198  | Télécharger l'article au format  
Keywords: Traumatic cardiac arrest; Pulseless electrical activity; Termination of resuscitation; Non-shockable rhythms; Return of spontaneous circulation; Prognosis

Article

Introduction : Trauma is a leading cause of preventable death, with a significant portion of trauma deaths occurring in the prehospital setting. Interventions such as chest drainage may play a critical role in managing life-threatening conditions but face challenges due to poorly defined indications and reliance on anecdotal evidence rather than rigorous studies. Among chest drainage techniques, finger thoracostomy (FT) is a well-described, but controversial, method for decompressing the pleural cavity in emergencies like tension pneumothorax or hemothorax. Despite its simplicity and minimal equipment requirements, FT carries risks, including bleeding, infection, organ injury, temporary effects, and procedural failure.

Méthode : This study examines eight FT procedures performed by Israel Defense Forces providers during the 2023-2024 "Swords of Iron" War in Gaza.

Résultats : All patients sustained severe penetrating injuries, with mixed outcomes. One case highlighted severe complications, including infection and empyema weeks later. Additionally, challenges in maintaining up-to-date knowledge and adherence to protocols among reservists led to unauthorized FT procedures, emphasizing the dangers of improvisation without evidence.

Conclusion : Our findings, coupled with limited evidence for FT's effectiveness in prehospital settings, raise questions about its appropriateness in trauma care. These concerns highlight the critical importance of adhering to validated and evidence-based protocols in all aspects of medical practice. Deviating from such protocols not only introduces unnecessary risks but also undermines the standardization essential for optimal patient care. Further research is needed to clarify the role, if any, of FT in prehospital trauma management.

Conclusion (proposition de traduction) : Nos résultats, associés à des preuves limitées de l'efficacité de la thoracostomie au doigt en milieu préhospitalier, soulèvent des questions quant à sa pertinence dans les soins de traumatologie. Ces préoccupations soulignent l'importance cruciale d'adhérer à des protocoles validés et fondés sur des preuves dans tous les aspects de la pratique médicale. S'écarter de ces protocoles n'introduit pas seulement des risques inutiles, mais nuit également à la standardisation essentielle pour des soins optimaux aux patients. Des recherches supplémentaires sont nécessaires pour clarifier le rôle éventuel de la thoracostomie au doigt dans la gestion préhospitalière des traumatismes.

Commentaire : Von Vopelius-Feldt J, Persaud A, Jones S, Drennan I, Cheskes S. Hemothorax and needle thoracostomies in prehospital traumatic cardiac arrest: an autopsy series of 172 cases. Resuscitation Plus. juin 2025;101012  .