Since the COVID-19 pandemic, there has been a sharp increase in adolescent care requests for suicidal ideation and behavior. At the same time, child and adolescent psychiatric resources have not kept pace with this rising demand. As a result, primary care professionals-general practitioners, emergency physicians, and pediatricians-are now on the front line for screening, assessment, and management. This article provides an update on current recommendations. A suicidal crisis is a transient and fluctuating process during which the individual's coping capacities are overwhelmed. Safety measures are therefore essential. Fewer than half of adolescents with suicidal ideation seek help. However, most adolescents have seen a physician in the month preceding a suicide attempt. Screening procedures are rapid, effective, and well standardized. Beyond the usual relational adjustments required when working with adolescents, assessment is facilitated by an empathic and engaged attitude. Emotional validation, reliability, and continuity of care are key elements. Involving the adolescent's family and close contacts is also crucial. The content of the assessment determines the level of urgency and vulnerability. It is structured around the RUD acronym: Risk (risk and protective factors), Urgency (level of distress, characteristics of suicidal thoughts, intentionality), and Dangerousness (scenario, planning, and access to lethal means). In addition to considering hospitalization, management includes securing the home environment by removing lethal means. It also involves providing guidance on what to do in case of worsening symptoms or recurrence. Information should be given about the disinhibiting effects of substance use, the availability of the national suicide prevention hotline (3114), the VIGILANS follow-up program, and appropriate care referral pathways..
Aims: The objective of this study is to investigate whether the point-of-care (POC) high-sensitivity troponin T result changes the orientation of patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) managed in the prehospital setting by mobile intensive care units (MICUs). Methods: Included patients were adults managed by the Piti & eacute;-Salp & ecirc;tri & egrave;re MICU between November2021 and October2023 for chest pain suggestive of ACS, and an on-site electrocardiogram that was either normal or suggestive of NSTE-ACS. This study compared the actual patient management strategy with the simulated strategy for the same patients, had the MICU doctor benefited from the on-site high-sensitivity troponin T results. The primary endpoint was the proportion of patients whose simulated management strategy differed from their actual management strategy. Results: A total of276 patients were included in the analysis. The simulated management strategy of patients with suspected NSTE-ACS, managed in the prehospital setting by the Piti & eacute;-Salp & ecirc;tri & egrave;re MICU, differed in 29% of cases compared to their observed management strategy (p < 0.001). Furthermore, high-sensitivity troponin T positivity was a significant independent predictor of patient disposition in multivariate analysis (adjusted OR 4.08 [95% CI: 2.18-7.80, p < 0.001]). Conclusion: In this study, the simulated triage of patients with suspected NSTE-ACS, managed prehospital with point-of-care Hs-cTnT measurement, differed from observed practice in nearly a third of cases.
Aims. This study aimed to document sound and verbal cues to abnormal breathing in emergency calls for out-of-hospital cardiac arrest, and to analyze their association with cardiac arrest recognition by emergency medical dispatchers (EMDs). Methods. In this observational study, we retrospectively identified cardiac arrest calls received by the Emergency Medical Services of Rh & ocirc;ne, France, over a 1-year period and analyzed the corresponding audio recordings. We documented the following: gasp-like background sounds, callers imitating the patient's abnormal breathing, callers describing the patient's breathing, and callers responding to EMD instructions to check breathing. Cases were independently coded by two authors for cardiac arrest recognition, and inter-coder reliability was assessed. Results. A sound or verbal cue suggesting abnormal breathing was identified in 89% of calls (139/156; 95% confidence interval [CI]: 86-92). Cardiac arrest was more frequently recognized in calls containing such cues; however, 21% of cases (29/139; 95% CI 18-24) were not recognized despite the presence of at least one cue. Conclusion. Emergency calls for out-of-hospital cardiac arrest frequently contain sound and verbal cues suggesting abnormal breathing, which may facilitate cardiac arrest recognition. However, such cues are not always identified or acted upon by EMDs. Cardiac arrest recognition during emergency medical dispatch could be improved by increasing attention to these cues and enhancing aware-ness of the range of expressions used by callers in local languages.
