Blood transfusions have been the cornerstone of life support since the introduction of the ABO classification in the 20th century. The physiologic goal is to restore adequate tissue oxygenation when the demand exceeds the offer. Although it can be a life-saving therapy, blood transfusions can lead to serious adverse effects, and it is essential that physicians remain up to date with the current literature and are aware of the pathophysiology, initial management and risks of each type of transfusion reaction. We aim to provide a structured overview of the pathophysiology, clinical presentation, diagnostic approach and management of acute transfusion reactions based on the literature available in 2022. The numbers of blood transfusions, transfusion reactions and the reporting rate of transfusion reactions differ between countries in Europe. The most frequent transfusion reactions in 2020 were alloimmunizations, febrile non-hemolytic transfusion reactions and allergic transfusion reactions. Transfusion-related acute lung injury, transfusion-associated circulatory overload and septic transfusion reactions were less frequent. Furthermore, the COVID-19 pandemic has challenged the healthcare system with decreasing blood donations and blood supplies, as well as rising concerns within the medical community but also in patients about blood safety and transfusion reactions in COVID-19 patients. The best way to prevent transfusion reactions is to avoid unnecessary blood transfusions and maintain a transfusion-restrictive strategy. Any symptom occurring within 24 h of a blood transfusion should be considered a transfusion reaction and referred to the hemovigilance reporting system. The initial management of blood transfusion reactions requires early identification, immediate interruption of the transfusion, early consultation of the hematologic and ICU departments and fluid resuscitation.

This paper describes how the profession of paramedics has evolved in Switzerland and takes the perspective of public health. Ambulance drivers play an important role in the health system, not only as a response to emergencies, but also by working in an interprofessional and interdisciplinary manner in response to other public health needs, such as home care, triage, telemedicine and interhospital transfers. This pre-hospital system is rapidly evolving and relies on the work of paramedics.

AIMS OF THE STUDY: As emergency department consultations rise across Europe, patients must be guided to obtain appropriate care at the right time and place.In Switzerland, the absence of a unique health number that would enable the avoidance of emergency services through telephone medical advice, and the shortage of general practitioners, redirecting low-severity patients from the emergency department before medical consultation to other healthcare facilities could help reduce emergency department overload. This study assessed the safety of a newly implemented redirection process by examining the rate of unexpected returns to any healthcare facility. METHODS: This monocentric cohort study included patients aged 18 or older who presented to the emergency department of a regional hospital in Switzerland between 1 January and 31 May 2023 and who accepted redirection before medical consultation. Patients were identified from our electronic medical registry and retrospectively enrolled after telephone interviews. The primary outcome was the rate of unexpected returns to any healthcare facility within 2 days of redirection. The secondary outcomes were the rate of returns within 7 days, hospital admissions, and patient satisfaction. RESULTS: Among 16,362 patients who came to the emergency department during the study period, 688 (4%) were redirected. A total of 321 patients were included in the final analysis after telephone interviews. The rate of unexpected returns to any healthcare facility after redirection was 4% within 2 days and 16% within 7 days. The rate of returns to any hospital was 1.2% within 2 days and 4.7% within 7 days after redirection. Six patients (2%) required hospitalisation, and no fatalities were reported. The mean satisfaction score was 3.9/5 (standard deviation [SD] = 1.1) for triage experience, 4.4/5 (SD = 1) for care received in partner clinics, and 3.7/5 (SD = 1) for the redirection process. CONCLUSION: The rate of unexpected returns to any healthcare facility after redirection was 4% within 2 days and 16% within 7 days. The implementation of this protocol appeared to provide safe redirection to nearby clinics for redirected low-acuity patients. Satisfaction with care received in partner clinics was high, although it was lower for the redirection process and triage experience.

Background: In the emergency department (ED), medical procedures, such as arterial blood gas (ABG) testing, can cause pain and high stress levels. However, ABG testing is a routine procedure assessing the severity of the patient's condition. To reduce the pain of ABG, several methods have been investigated without significant difference in pain perception. Communication, a key element of care, has shown a significant effect on pain perception. A positive communication strategy, including positive, kind, or reassuring words, can reduce pain perception, while negative words can raise this perception, causing discomfort, known as the “nocebo effect.” Although some studies have compared the impact of verbal attitudes, particularly in anesthesia and mainly with staff already trained in hypnosis, to the best of our knowledge, none have investigated the effect of communication in the emergency setting, where patients may be more suggestible to the words used. Objective: In this study, we will investigate the effect of positive therapeutic communication on pain, anxiety, discomfort, and global satisfaction in patients requiring ABG compared to nocebo and neutral communication. Methods: A single-center, double-blind randomized controlled trial (RCT) with 3 parallel arms will be conducted with 249 patients requiring ABG during their ED visit. Patients will be randomly assigned to 1 of 3 groups before receiving ABG: positive communication group, negative communication (nocebo) group, or neutral communication (neutral) group. The communication and the words used by the physicians during hygiene preparation, artery location, and puncture will be imposed in each group. The study will be proposed to each patient corresponding to the inclusion criteria. The physicians will not be trained in hypnosis or in positive therapeutic communication. The procedure will be recorded with audio recorders to test its quality. Intention-to-treat analysis will be performed. The primary endpoint is the onset of pain. The secondary outcomes are patient comfort, patient anxiety, and global satisfaction of the patient with the communication strategy used. Results: On average, 2000 ABG procedures are performed each year in the EDs of hospitals. In this study, 249 patients are expected to be included. With a projected positive response rate of 80%, we intend to include 25 (10%) patients per month. The inclusion period began in April 2023 and will run until July 2024. We hope to publish the results of the study during the fall of 2024. Conclusions: To the best of our knowledge, this study is the first RCT assessing the use of positive communication on pain and anxiety in patients undergoing the ABG procedure in the ED. A reduction in pain, discomfort, and anxiety is expected when using positive communication. If the results are positive, this could be useful to the medical community and encourage clinicians to monitor their communication during care. Trial Registration: ClinicalTrials.gov NCT05434169; https://clinicaltrials.gov/ct2/show/NCT05434169 International Registered Report Identifier (IRRID): PRR1-10.2196/42043

Le cathétérisme intra-osseux permet un accès vasculaire rapide, facile, sûr et efficace pour l’administration de thérapeutiques urgentes, chez l’enfant...

The ability of triage nurses to quickly identify an urgent situation is crucial and requires good clinical reasoning, which is strongly influenced by the context and professional environment. To explore how triage nurses generate initial hypotheses at the very start of the triage encounter and which immediately available cues contribute to this early sense-making. This qualitative study was conducted in three regional hospitals and included 10 triage nurses. Nurses wore a forehead-mounted GoPro camera to record triage from their point of view. Semi-structured, video-cued recall interviews were conducted immediately after triage. Deductive and inductive coding was then carried out and analysed using thematic analysis methods. The average age of triage nurses was 36 years, with an average of 6.5 years of professional experience in the emergency department. Triage nurses generated hypotheses as soon as they encountered the patient, largely through pattern recognition (a core mechanism associated with intuition). These hypotheses were sometimes made as soon as the patient was registered at the emergency desk reception and even before talking to them. These hypotheses were based on the patient's main presenting complaint, their facial expression, and the time reported for the onset of symptoms. Triage nurses operate in a complex environment and use rapid clinical reasoning processes that draw on readily available cues and prior experience. These findings may inform triage education by highlighting the early, experience-based processes involved in hypothesis generation and the potential value of explicitly addressing intuitive reasoning in triage training.