Deliberate drug poisoning leads to 1% of emergency department (ED) admissions. Even if most patients do not exhibit any significant complication, 5% need to be referred to an intensive care unit (ICU). Emergency physicians should distinguish between low-and high-acuity poisoned patients at an early stage to avoid excess morbidity. Our aim was to identify ICU transfer factors in deliberately self-poisoned patients without life-threatening symptoms on admission. We performed a 3-year retrospective observational study in a university hospital. Patients over 18 years of age with a diagnosis of deliberate drug poisoning were included. Clinical and toxicological data were analysed with univariate tests between groups (ED stay versus ICU transfer). Factors associated with ICU admission were then included in a logistic regression analysis. Two thousand five hundred and sixtyfive patients were included. 63.2% were women, and median age was 40 (28-49). 142 patients (5.5%) were transferred to ICU. Cardiac drugs [adjusted OR (aOR) = 19.81; 95% confidence interval (95% CI): 7.93-49.50], neuroleptics (aOR = 2.78; 95% CI: 1.55-4.97) and meprobamate (aOR = 2.71; 95% CI: 1.27-5.81) ingestions were significantly linked to ICU admission. A presumed toxic dose ingestion (aOR = 2.27; 95% CI: 1.28-4.02), number of ingested tablets (aOR = 1.01; 95% CI: 1.01-1.02 for each tablet) and delay between ingestion and ED arrival <2 hr (aOR = 2.85; 95%CI: 1.62-5.03) were also factors for ICU referral. The Glasgow Coma Scale was the only clinical feature associated with ICU admission (aOR = 1.57; 95% CI: 1.44-1.70 for each point loss). These results suggest that emergency physicians should pay particular attention to toxicological data on ED admission to distinguish between low-and high-acuity self-poisoned patients.Deliberate drug poisoning (DDP) is a major public health problem with more than 210,000 patients hospitalized in the United States in 2010 [1]. The annual incidence of DDP is around 2-6& in most western countries and DDP accounts for 1% of all emergency department (ED) visits [1][2][3][4]. One major problem concerning the ED management of such a high number of DDP patients is the respective proportion of lowand high-acuity patients. On the one hand, the vast majority of DDP patients attending the ED do not have any severe symptoms and do not require any specific intervention [5,6]. Inappropriate recognition of such patients lead to unnecessary laboratory testing and/or ward monitoring, and it finally contributes to overcrowding [7,8]. On the other hand, around 5% of DDP patients exhibit complications, with an increased mortality rate up to 10-20% [9,10]. Appropriate identification of severe DDP is therefore crucial to avoid delayed intensive treatments and increased in-hospital mortality [11][12][13][14].Emergency physicians cannot rely on strong and validated indicators for the assessment of DDP patients. Although severity factors for specific intoxications are usually well-known, few data exist about patients overdosed w...

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In France, one in eight patients with acute ST-segment elevation myocardial infarction (STEMI) is admitted direct to an emergency department (ED) in a hospital without percutaneous coronary intervention (PCI) facilities. Guidelines recommend transfer to a PCI center, with a door-in to door-out (DI–DO) time of ≤30 min. We report DI–DO times and identify the main factors affecting them. RESURCOR is a French Northern Alps registry of patients with STEMI of <12 h duration. We focused on patients admitted direct, without prehospital medical care, to EDs in 19 non-PCI centers from 2012 to 2014. We divided DI–DO time into diagnostic time (ED admission to call for transfer) and logistical time (call for transfer to ED discharge). Among 2007 patients, 240 were admitted direct to EDs in non-PCI centers; 57.9% were treated with primary angioplasty and 32.9% received thrombolysis. Median (interquartile range) DI–DO time was 92.5 (67–143) min, with a diagnostic time of 41 (23–74) min and a logistical time of 47.5 (32–69) min. Five patients (2.1%) had a DI–DO time ≤30 min. Five variables were independently associated with a shorter DI–DO time: local transfer (mobile intensive care unit [MICU] team available at referring ED) (P = .017) or transfer by air ambulance (P = .004); shorter distance from referring ED to PCI center (P < .001); shorter time from symptom onset to ED admission (P = .002); thrombolysis (P = .006); and extended myocardial infarction (P = .007). In view of longer-than-recommended DI–DO times, efforts are required to promote urgent local transfer and use of thrombolysis.

Les descriptions de l’incidence, de la gravité et des modalités de prise en charge des blocs auriculoventriculaires du troisième degré (BAV3) compliquant la phase aiguë des infarctus du myocarde, avec sus-décalage du segment ST (STEMI), sont rares et anciennes. Par ailleurs, les modalités de prise en charge des STEMI aigus ont beaucoup évolué. Le but de notre étude est d’évaluer l’incidence, de décrire la gravité et les modalités de prise en charge des BAV3 survenant à la phase aiguë des STEMI dans un contexte contemporain. Matériel et méthodes : Nous avons réalisé une étude observationnelle rétrospective de la prise en charge des STEMI aigus à partir du registre prospectif des STEMI du Réseau nord alpin des urgences (RENAU) sur les 19 hôpitaux des Alpes du Nord entre 2009 et 2012. Les patients présentant un BAV3 à la phase initiale de leur prise en charge ont été identifiés. Résultats : Deux mille sept cent neuf patients avec STEMI aigu ont été inclus sur la période d’étude. Cinquante-sept ont présenté un BAV3 (2 %). Cent cinquante-deux des 2 648 patients sans BAV3 (6 %) sont décédés à la phase hospitalière contre 7 des 57 patients (12 %) avec BAV3 (p = 0,047). Parmi les patients en BAV3, un traitement par atropine a été utilisé pour 26 patients et s’est révélé efficace pour (15 %) d’entre eux. L’isoprénaline a été utilisée pour huit patients et a induit une hypotension artérielle pour quatre d’entre eux. Une stimulation ventriculaire droite percutanée a été utilisée pour six patients et a toujours été efficace. Quatorze patients ont été thrombolysés (25 %). Une angioplastie de sauvetage a été nécessaire chez 10 des 14 patients en BAV3 traités par thrombolyse (71 %), comparés aux 325 des 840 patients sans BAV3 traités par thrombolyse (39 % ; p = 0,013). Conclusion : L’incidence des BAV3 à la phase aiguë des STEMI est faible. Le BAV3 représente un facteur de sévérité. Les stratégies thérapeutiques sont d’efficacité inégale, avec des effets indésirables induits par l’isoprenaline. La thrombolyse chez ces patients est moins efficace.