Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association.

This paper provides an update on the European Society of Cardiology task force report on the management of chest pain. Its main purpose is to provide an update on the decision algorithms and diagnostic pathways to be used in the emergency department for the assessment and triage of patients with chest pain symptoms suggestive of acute coronary syndromes

Consideration of the human factor in the design and conception of a manual ventilation feedback device

La réanimation cardiopulmonaire est au cœur de la médecine depuis toujours. Comme Aristote l’a si bien dit : « nous devons saisir l'opportunité d'apporter de l'aide, avant qu'elle ne s'échappe. Et c'est comme ça que nous sauverons le patient ». Les médecins et les scientifiques n’ont eu de cesse depuis, que de développer de nouveaux dispositifs pour rendre cette technique efficace et sauver plus de vies. L’ingénierie biomédicale s’est développée, et de nombreuses innovations ont vu le jour, avec ou sans tenir compte des avis des utilisateurs finaux, et très souvent sans tests préalables en conditions de pratique clinique. La règlementation, naguère un peu laxiste, s’est durcie au fil des défaillances techniques et surtout des problèmes d’usage apparus au décours de l’utilisation de ces dispositifs. Une mise à jour récente de la règlementation, impose entre autre, de considérer le facteur humain dans chacune des étapes du développement du dispositif médical de sa conception à son usage quotidien. Les experts savent que la ventilation est essentielle pour la survie. Cependant, très peu de dispositifs existent pour aider au monitorage de cette ventilation durant la réanimation d’une victime d’un arrêt cardiopulmonaire. Nous avons voulu dans ce travail illustrer la manière de prendre en compte ce facteur humain tout au long des étapes de développement d’un nouveau dispositif médical d’aide à la ventilation manuelle dans l’arrêt cardiaque : de l’analyse du besoin et de l’environnement d’utilisation des utilisateurs finaux qui sont les soignants à l’hôpital, en pré-hospitalier, mais aussi les pompiers, ambulanciers ou secouristes, en passant par la preuve de concept technique et les itérations du prototypage, jusqu’à la validation clinique du produit final qui sera marqué CE et/ ou FDA « approved ».Cardiopulmonary resuscitation has always been at the heart of medicine. As Aristotle said: “We must seize the opportunity to help, before it escapes. And that is how we save the patient”. Since then, physicians and scientists have been developing new devices to make this technique effective and save more lives. Biomedical engineering has developed, and many innovations have emerged, with or without regard to the opinions of end-users, and very often without prior testing under clinical conditions. The regulations, which used to be somewhat lax, have recently become stricter as a result of technical failures and, above all, problems of use that have arisen during the use of these devices. A recent update of the regulations requires, among other things, to consider the human factor in each step of the development of the medical device from its design to its daily use. Experts know that ventilation during the resuscitation of a cardiac arrest patient is essential for survival. However, very few devices exist to help monitor this ventilation during resuscitation of a victim of cardiopulmonary arrest. In this work, we wanted to illustrate how to take into account this human factor throughout the development stages of a new medical device to assist manual ventilation in cardiac arrest patients. The development starts first with the analysis of the need and the environment of use of the final users. These users are the caregivers in the hospital, the healthcare professionals in the pre-hospital setting, but also the firefighters, paramedics or rescue workers in the emergency and acute care medicine. At later stages, comes the technical proof of concept and the iterations of prototyping, until the clinical validation of the final product that will lead to a CE and/or FDA approved device

A fast method for the calculation of radiation heat transfer coefficients in a continuous reheating furnace.

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European Society For Emergency Medicine position paper on emergency medical systems' response to COVID-19

The 2019 novel coronavirus acute respiratory epidemic is creating a stressed situation in all the health systems of the affected countries. Emergency medical systems and specifically the emergency departments as the front line of the health systems are suffering from overload and severe working conditions, the risk of contagion and transmission of the health professionals adds a substantial burden to their daily work. Under the perspective of European Society For Emergency Medicine, the recommendations provided by the health authorities are reviewed focus on the emergency department's activity.status: publishe

From Mouth-to-Mouth to Bag-Valve-Mask Ventilation: Evolution and Characteristics of Actual Devices—A Review of the Literature

Manual ventilation is a vital procedure, which remains difficult to achieve for patients who require ventilatory support. It has to be performed by experienced healthcare providers that are regularly trained for the use of bag-valve-mask (BVM) in emergency situations. We will give in this paper, a historical view on manual ventilation’s evolution throughout the last decades and describe the technical characteristics, advantages, and hazards of the main devices currently found in the market. Artificial ventilation has developed progressively and research is still going on to improve the actual devices used. Throughout the past years, a brand-new generation of ventilators was developed, but little was done for manual ventilation. Many adverse outcomes due to faulty valve or misassembly were reported in the literature, as well as some difficulties to ensure efficient insufflation according to usual respiratory parameters. These serious incidents underline the importance of BVM system routine check and especially the unidirectional valve reassembly after sterilization, by only experienced and trained personnel. Single use built-in devices may prevent disassembly problems and are safer than the reusable ones. Through new devices and technical improvements, the safety of BVM might be increased

European Society of Emergency Medicine position paper on the one-hour sepsis bundle of the Surviving Sepsis Campaign: expression of concern

International audienceIn 2018 the Surviving Sepsis Campaign issued new guidance with a revised version of their sepsis bundle. Instead of the 2016 3-hour sepsis bundle, the Surviving Sepsis Campaign now recommends that blood cultures, lactate measurement, broad-spectrum antibiotic therapy and 30 ml/kg crystalloid fluid administration should be initiated within 1 hour after triage. The European Society of Emergency Medicine wishes to express its concerns regarding the low level of evidence that underlies this guidance, and the potential implications from an emergency physician point of view

Impact of a visual indicator on the noise level in an emergency medical dispatch centre - a pilot study

International audienceBackground: Noise levels are monitored in call centres. A maximum of 52 to 55 dB(A) is recommended in order to prevent adverse events. We aimed at assessing the noise level and the impact of a visual noise indicator on the ambient noise level in a French Regional Emergency Medical Dispatch Centre (EMDC). Methods: We conducted an observational study in the EMDC of the SAMU25 (University Hospital of Besancon). We measured the noise level using a SoundEarII® noise indicator (Dräger Medical SAS, France). The measurement took place in two phases on three consecutive days from 00:00 to 11:59 PM. At baseline, phase 1, the device recorded the average ambient noise for each minute without visual indication. Secondly, phase 2 included a sensor mounted with a light that would turn on green if noise was below 65 dB(A), orange if noise ever exceeded 65 and red if it exceeded 75 dB(A). Results: In the presence of the visual noise indicator, the L Aeq was significantly lower than in the absence of visual noise indicator (a mean difference of − 4.19 dB; P < 10-3). It was higher than 55 dB(A) in 84.9 and 43.9% of the time in phases 1 and 2, respectively. Conclusions: The noise levels were frequently higher than the standards, and sometimes close to recommended limits, requiring preventive measures. The noise indicator had a positive effect on the ambient noise level. This work will allow the implementation of effective prevention solutions and, based on future assessments, could improve operators' well-being and better care for patient