Selestat

Small Bowel Obstruction (SBO) often leads to emergency department visits and is usually diagnosed using an abdominal CT scan. Although CT scans help guide treatment decisions such as surgery or medical management, they have drawbacks including radiation exposure, higher costs, and longer emergency department stays. Researchers are evaluating the use of Point of Care Ultrasound (POCUS) combined with a clinical assessment called Gestalt probability to safely rule out SBO in patients with low or moderate risk, potentially reducing the need for CT scans. In this diagnostic multicenter study, trained emergency physicians perform POCUS on patients presenting with suspected SBO who have been assessed as having low or moderate Gestalt clinical probability. The ultrasound looks for signs of SBO in nine abdominal zones using a curvilinear probe. After POCUS, all patients undergo a CT scan, which serves as the gold standard for confirming SBO. The study aims to assess the ability of POCUS to exclude SBO in this patient group, with participation lasting 28 days including follow-up. Participants are involved during their emergency department visit with POCUS and CT imaging, followed by a phone call at 28 days. Researchers collect information on POCUS findings, duration, difficulty, and investigator details, while CT results are interpreted independently. The main outcome measures include the accuracy of POCUS to rule out SBO in patients with low or moderate Gestalt probability, aiming to improve patient care by reducing unnecessary CT scans, radiation exposure, costs, and radiologist workload.

Researchers are evaluating an optimized strategy to reduce complications related to emergency tracheal intubation in adults experiencing vital distress. The study focuses on combining three interventions: using rocuronium as a paralytic agent to ease intubation, providing bag face-mask ventilation before intubation, and systematically using a Gum Elastic Bougie (GEB) to assist the first intubation attempt. This approach aims to lower the risks and morbidity associated with emergency intubations, especially in out-of-hospital settings. The study compares two approaches for rapid sequence intubation (RSI). One group receives rocuronium at 1.2 mg/kg with bag-mask ventilation between induction and laryngoscopy, and GEB is used systematically on the first attempt. The other group follows standard recommendations using succinylcholine at 1 mg/kg without systematic bag-mask ventilation, and GEB is only used if intubation fails under direct laryngoscopy. Emergency physicians will record immediate outcomes after out-of-hospital care and hospital data will be collected on day 28 after inclusion. Participants will undergo medical history review and physical examination including measurements of arterial pressure, oxygen saturation, and heart rate. The main outcome measured is the occurrence of severe complications related to intubation during the first hour after the procedure. Data collection includes out-of-hospital and intra-hospital monitoring, with follow-up to 28 days. This trial seeks to assess whether the combined strategy can improve safety and reduce intubation-related complications in emergency situations.

Researchers are comparing two outpatient treatments for adults aged 18 to 50 who have primary spontaneous large pneumothorax, a condition where air collects in the space around the lungs without an obvious cause. The study aims to find which method is more effective: using a Fuhrman catheter with a unidirectional valve or performing simple exsufflation. Currently, there is no clear consensus on the best management approach for this condition. The study involves two treatment groups. One group receives a Fuhrman catheter placement combined with outpatient monitoring through pneumology consultations. The other group undergoes simple exsufflation, a procedure to remove air from the chest. Both treatments are performed as outpatient procedures, allowing patients to be managed without hospital admission. Participants will be monitored to assess the success of ambulatory care by the sixth day after treatment. Researchers will evaluate how well each treatment manages the pneumothorax and track patient outcomes during follow-up visits. The study focuses on comparing the effectiveness and feasibility of these two outpatient strategies for managing spontaneous pneumothorax.