Fournier\'s gangrene is characterized by an acute necrotic infection. The infection can occur in all parts of the body including the scrotum, penis, or perineum, and is a rare condition that is primarily reported in men and seldom in women. Existing literature suggests that it might be underreported, possibly leading to overlooked cases. Risk factors include diabetes, chronic illness, and trauma. This case involves a 52-year-old female with a 10-year medical history of diabetes mellitus, multiple healed skin lesions all over the body, and dermatitis. The presentation was a perianal swelling, which progressed into an extensive necrotizing soft tissue infection of the perineum, making a diagnosis of Fournier\'s gangrene. She underwent wide local debridement and was managed with antibiotics in a timely manner. The patient\'s clinical course and subsequent follow-up were uneventful. Uncontrolled diabetes and dermatitis significantly increase the risk of Fournier\'s gangrene; therefore, it should be suspected in women with such comorbid conditions. This case highlights the need for increased awareness and vigilance regarding this condition among women.

In the management of severe trauma, the aim is to assess the patient\'s clinical stability as quickly as possible, enabling referral to imaging (whole-body CT scan, embolization if necessary) or the operating room, or even the decision to perform in situ surgery (resuscitation thoracotomy). To cope with these critical situations, team training is essential, with the aim of ensuring the reproducibility of the difficulties encountered. High-fidelity in situ simulation is the ideal tool for meeting this training challenge.

Congenital adrenal hyperplasia (CAH) is a type of primary adrenal insufficiency (AI) that predisposes to adrenal crisis (AC) during stress. We describe a case of a primipara with CAH who was admitted in labor. To prevent AC, glucocorticoid replacement was given according to guidelines. Due to fetal decelerations, an emergency C-section was performed under general anesthesia following which refractory hypotension emerged. The diagnosis of AC was considered, and hydrocortisone was given with sustained hemodynamic improvement. AC is a life-threatening emergency whose diagnosis requires a high index of suspicion. Despite adequate steroid coverage, additional stressors may precipitate AC, so it is of paramount importance that anesthesiologists consider this emergency.

When participating in activities related to emergency medical assistance, especially without medical presence, the firefighter nurse develops many skills. As a firefighter officer, he has a global and strategic vision of the response, which goes beyond the field of nursing skills to take on a civil security dimension. When he takes care of the victim, the clinical reasoning of the nurse, who intervenes alone, is crucial.

Background Foreign body aspiration (FBA) is a life-threatening event and one of the most common causes of mortality in children. As it has different clinical presentations, parental knowledge is essential for early management to prevent complications. Objectives This study was designed to assess the knowledge and practices relating to FBA in children among parents living in Makkah city, Saudi Arabia. Methods An online questionnaire was designed using Google Forms (Google LLC, Mountain View, California, United States) and distributed in October 2022 among parents living in Makkah city. After data collection, an appropriate statistical analysis was conducted. Results A total of 1087 parents enrolled in this study; 63.9% were women and the majority were married 93%. Additionally, 52% of the parents had at least three children. Moreover, 17.6% had an experience of a child having aspirated a foreign body once. The Internet was the most popular source of information on FBA (43.5%). Furthermore, the parents had poor levels of knowledge and practices related to FBA (65.4% and 78.6%, respectively). Conclusion This study reported that parental levels of knowledge of FBA and FBA practices were inadequate. There is a need to increase awareness, which will lead to better outcomes.

BACKGROUND: Basic emergency management in urban and rural areas is a critical challenge, which can affect the pre-hospital mortality rate. Therefore, Non-hospital Healthcare Center (NHHC) must be prepared to manage such emergency cases that may occur in the geographic area where these centers act. The main aim of the study was to develop and validate an toolbar for NHHCs\' preparedness to provide initial emergency care.
METHODS: This study was designed based on a sequential exploratory mixed- method in two phases, in each of which there are three steps. In the phase I, the literature systematic review and qualitative methods (Focus Group Discussions (FGDs) and Semi-Structured Interviews (SSIs)) were applied to identify the domains and items. In the phase II, content validity, feasibility, and reliability of the toolbar were performed. Content validity was assessed using a modified Kappa coefficient based on clarity and relevance criteria. Feasibility of the toolbar was randomly assessed through its implementation in 10 centers in Tabriz. Reliability was randomly assessed in a pilot on 30 centers. Reliability was assessed by measuring internal consistency, test-retest reliability, and inter-rater agreement. The main statistical methods for assessing reliability include Cronbach\'s alpha, Intra-class Correlation Coefficient, and Kendal\'s Tau-b. All the statistical analyses were performed using Stata 14.
RESULTS: In the phase I, primary version of the toolbar containing 134 items related to assessing the preparedness of NHHCs was generated. In the phase II, item reduction was applied and the final version of the toolbar was developed containing 126 items, respectively. These items were classified in 9 domains which include: \"Environmental Infrastructures of Centers\", \"Protocols, Guidelines and Policies\", \"Medical Supplies and Equipment\", \"Emergency Medicines\", \"Human Resources\", \"Clinical Interventions\", \"Maintenance of equipment\", \"Medicine Storage Capability\", and \"Management Process\". The toolbar had acceptable validity and reliability.
CONCLUSIONS: This study provided a standard and valid toolbar that can be used to assess the preparedness of NHHCs to deliver initial emergency care.

BACKGROUND: Children have the right to the best possible medical care. The lack of treatment capacity is rising steadily and increasingly leads to forced centralized allocation of patients by the emergency medical services (EMS) to pediatric emergency departments that are, officially, temporarily \"closed\".
OBJECTIVE: The aim of this study is to present trends in allocation of pediatric emergency patients in greater Munich.
METHODS: Retrospective analysis of hospital admissions of children < 18 years of age collected from 01 January 2015 to 31 December 2019 by means of the web-based IT system IVENA eHealth (manis IT, Frankfurt) used by the emergency medical services. The focus of the evaluation is on patients in category II, who are likely to require inpatient admission.
RESULTS: During the 5‑year observation period, a total of 44,549 pediatric patients < 18 years of age (90.6% of total admissions) were admitted to a children\'s hospital by the ambulance service as category II (SKII) in the Munich metropolitan area. These patients showed an increase in the relative frequency of forced allocations from 1.7% (2015) to 9.4% (2019). Parallel to this, there is an increasing frequency of time intervals over the years in which all children\'s hospitals were temporarily closed due to lack of treatment availability, especially in the winter half-year.
CONCLUSIONS: In the examined period from 2015 to 2019, there has been a relevant increase in the number of forced allocations to children\'s hospitals by the emergency medical services in the Munich area. This observed trend is likely to persist over the coming years, in view of current staff shortages and diminishing hospital capacities.
UNASSIGNED: HINTERGRUND: Kinder haben Anspruch auf eine bestmögliche medizinische Versorgung. Zunehmende Versorgungsengpässe durch fehlendes Behandlungskapazitäten führen zu einer Gefährdung dieses Anspruchs und zunehmenden Abmeldung der Kinderkliniken von der Rettungsleitstelle.
UNASSIGNED: Ziel dieser Studie ist die Darstellung der stationären Kindernotfallversorgung am Beispiel einer Großstadt und der Notwendigkeit sog. Akutbelegungen als primärer Endpunkt mangelnder Versorgungskapazitäten.
UNASSIGNED: Retrospektive Analyse der über den Zeitraum vom 01.01.2015 bis 31.12.2019 erhobenen Krankenhauseinweisungen von Kindern < 18 Jahre mittels des durch die Rettungsleitstelle verwendeten webbasierten IT-Systems IVENA eHealth (manis IT, Frankfurt, Deutschland). Der Fokus der Auswertung liegt auf den Patienten der Sichtungskategorie (SK) II, die voraussichtlich eine stationäre Aufnahme benötigen.
UNASSIGNED: Im 5‑jährigen Beobachtungszeitraum wurden im Großraum München insgesamt 44.549 pädiatrische Patienten < 18 Jahre (90,6 % der Gesamtzuweisungen) durch den Rettungsdienst als SKII in eine Klinik eingewiesen. Bei diesen Patienten zeigte sich ein Anstieg der relativen Häufigkeit von Akutbelegungen von 1,7 % (2015) auf 9,4 % (2019). Parallel hierzu zeigt sich eine über die Jahre zunehmende Häufigkeit der Zeitintervalle, in denen vor allem im Winterhalbjahr alle Kinderkliniken abgemeldet sind.
UNASSIGNED: Im untersuchten Zeitraum von 2015 bis 2019 ist es im Rettungsdienstbereich München zu einem relevanten Anstieg der Anzahl von Akutbelegungen in den Kinderkliniken durch die Rettungsleitstelle gekommen. Diese Studie belegt mit ihren objektivierbaren Daten den sich über Jahre chronifizierenden Engpass in der pädiatrischen Notfallversorgung in einer Metropolregion.

BACKGROUND: Management of Life-threatening Emergency (LTE) patients in urban and rural areas is an important challenge, which can affect pre-hospital mortality rate. Therefore, Non-hospital Health Center (NHHC) must be prepared to manage such emergency cases that may occur in the geographic area where these centers act. The aim of this study was to explore domains related to the preparedness of NHHCs to manage LTE patients through resorting to healthcare providers\' and experts\' perspectives.
METHODS: A qualitative exploratory study was applied using Semi-Structured Interviews (SSIs) and Focus Group Discussions (FGDs). Prior to beginning data collection, the study and its objectives were explained to the participants and their informed consents were obtained. Then, SSIs and FGDs were conducted by two trained researchers using an interview guide, which was developed through literature review and consulting experts. In total, 12 SSIs were done with the providers at different NHHCs in Tabriz. In addition, 2 FGDs were conducted with the specialists in Emergency Medicine (EM) and Primary Health Care (PHC), and the executives of health centers, with over 5 years of work experience, and Emergency Medical Services (EMS) experts. Purposive sampling method was used in this study. All SSIs and FGDs were audio recorded and subsequently transcribed. Framework Analysis was employed to manually analyze the interview transcripts from all the SSIs and FGDs.
RESULTS: The interview transcripts analysis resulted in the emergence of 3 themes and 11 sub-themes, categorized according to Donabedian\'s triple model. 5 sub-themes were related to input, including medical equipment and supplies, environmental infrastructures of the centers, emergency medicines, human resource, and protocols, guidelines and policies. 4 sub-themes were related to process, including providing clinical services, medicine storage capacity, maintenance of equipment, and management process. Finally, 2 sub-themes were related to outcome, which were patients\' satisfaction with the quality of care and improved survival of LTE patients.
CONCLUSIONS: The results of this study can provide a new perspective for health managers and policy makers on how to evaluate the preparedness of NHHCs in managing LTE patients. In addition, it will be used to develop instruments to measure the preparedness of these centers.

BACKGROUND: Any dental surgeon may be faced with a critical life-threatening emergency situation. In our university, all students in dentistry receive a standard course on emergency first aid. The aim of this prospective, comparative, single-centre study was to determine whether additional training on a high-fidelity patient simulator would improve student performance.
METHODS: After approval by an Ethical Committee and written informed consent, the students of the Simulation group (n=42) had full-scale high-fidelity training on a patient simulator SimMan 3G™ (3 hours by six students). They participated in pairs in two scenarios (airway obstruction, seizures, allergies, vasovagal syncope, asthma, chest pain). The first scenario was simple, and the second was a progression to cardiac arrest. Three months later, the Simulation group and the Control group (n=42) participated in a test session with two scenarios. The primary end point was the score at the test session (with a standardised scoring grill, direct observation and audio-video recording). Data were median and 25%-75% percentiles.
RESULTS: High-fidelity training strongly improved the score on the test obtained by the students of the Simulation group (146 [134-154]) which was much higher (P<.0001) than in the Control group (77 [67-85]). Technical as well as non-technical skills components of the scores were improved. In addition, performances of the Simulation group were increased between the training and the test. Simulation session was very positively assessed by the students.
CONCLUSIONS: The results support the systematic introduction of training to critical life-threatening emergency situations on high-fidelity patient simulators the dentistry curriculum. The impact on clinical practice in the dental office remains to be assessed.

Private practice professionals providing care in patients\' homes are often isolated. The care is controlled by a multidisciplinary care network. In the event of a life-threatening emergency, the Aide Médicale Urgente control centre activates if necessary the rapid intervention of emergency services. An accurate assessment, the anticipation of an emergency transfer to hospital and knowledge of the regulatory framework ensure the patient is handled efficiently and respectfully.