{"id":142,"date":"2020-12-14T13:33:34","date_gmt":"2020-12-14T12:33:34","guid":{"rendered":"https:\/\/onetech.dev\/covid\/?page_id=142"},"modified":"2026-04-22T15:17:18","modified_gmt":"2026-04-22T14:17:18","slug":"urgences","status":"publish","type":"page","link":"https:\/\/onetech.dev\/covid\/urgences","title":{"rendered":"Urgences"},"content":{"rendered":"<section class=\"l-section wpb_row height_small\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_grid cols_1 laptops-cols_inherit tablets-cols_inherit mobiles-cols_1 valign_top type_default stacking_default\"><div class=\"wpb_column vc_column_container type_sticky\"><div class=\"vc_column-inner\" style=\"top:180px\"><div class=\"w-image us_custom_fb33871a us_animate_this has_height align_center\"><div class=\"w-image-h\"><img decoding=\"async\" width=\"900\" height=\"127\" src=\"https:\/\/onetech.dev\/covid\/data\/irc_logo.png\" class=\"attachment-full size-full\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/onetech.dev\/covid\/data\/irc_logo.png 900w, https:\/\/onetech.dev\/covid\/data\/irc_logo-300x42.png 300w, https:\/\/onetech.dev\/covid\/data\/irc_logo-150x21.png 150w\" sizes=\"auto, (max-width: 900px) 100vw, 900px\" \/><\/div><\/div><div class=\"ult-spacer spacer-69f4102da66e6\" data-id=\"69f4102da66e6\" data-height=\"35\" data-height-mobile=\"35\" data-height-tab=\"35\" data-height-tab-portrait=\"\" data-height-mobile-landscape=\"\" style=\"clear:both;display:block;\"><\/div><h3 class=\"w-text us_custom_7ccf62ca has_text_color\"><span class=\"w-text-h\"><span class=\"w-text-value\">RECOMMANDATIONS G\u00c9N\u00c9RALES<\/span><\/span><\/h3><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_small\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_grid cols_1 laptops-cols_inherit tablets-cols_inherit mobiles-cols_1 valign_top type_default stacking_default\"><div class=\"wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"g-cols wpb_row via_grid cols_2-1 laptops-cols_inherit tablets-cols_inherit mobiles-cols_1 valign_top type_default stacking_default\" style=\"--columns-gap:3rem;\"><div class=\"wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"aio-icon-component    style_2\"><a class=\"aio-icon-box-link\" ><div id=\"Info-box-wrap-7650\" class=\"aio-icon-box left-icon\" style=\"\"  ><div class=\"aio-icon-left\"><div class=\"ult-just-icon-wrapper  \"><div class=\"align-icon\" style=\"text-align:center;\">\n<div class=\"aio-icon-img \" style=\"font-size:50px;background:#03254C;border-style:solid;border-color:#03254C;border-width:1px;padding:20px;border-radius:500px;display:inline-block;\" >\n\t<img decoding=\"async\" class=\"img-icon\" alt=\"null\" src=\"https:\/\/onetech.dev\/covid\/data\/ambulance.png\"\/>\n<\/div><\/div><\/div><\/div><div class=\"aio-ibd-block\"><div class=\"aio-icon-header\" ><h6 class=\"aio-icon-title ult-responsive\"  data-ultimate-target='#Info-box-wrap-7650 .aio-icon-title'  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}'  style=\"font-weight:bold;color:#03254C;\">Urgences<\/h6><\/div> <!-- header --><\/div> <!-- aio-ibd-block --><\/div> <!-- aio-icon-box --><\/a><\/div> <!-- aio-icon-component --><\/div><\/div><div class=\"wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"w-btn-wrapper align_right\"><a class=\"w-btn us-btn-style_1 icon_atleft\" href=\"https:\/\/onetech.dev\/covid\/\"><i class=\"far fa-backward\"><\/i><span class=\"w-btn-label\">Retour<\/span><\/a><\/div><\/div><\/div><\/div><div class=\"ult-spacer spacer-69f4102da757b\" data-id=\"69f4102da757b\" data-height=\"25\" data-height-mobile=\"25\" data-height-tab=\"25\" data-height-tab-portrait=\"\" data-height-mobile-landscape=\"\" style=\"clear:both;display:block;\"><\/div><div class=\"g-cols wpb_row via_grid cols_1 laptops-cols_inherit tablets-cols_inherit mobiles-cols_1 valign_top type_default stacking_default\" style=\"--columns-gap:3rem;\"><div class=\"wpb_column vc_column_container us_custom_7e20fa79 us_animate_this\"><div class=\"vc_column-inner\"><div class=\"w-tabs us_custom_064d3121 style_default switch_click accordion has_scrolling\" style=\"--sections-title-size:18px\"><div class=\"w-tabs-sections titles-align_none icon_chevron cpos_right\"><div class=\"w-tabs-section active\" id=\"v0c9\"><button class=\"w-tabs-section-header active\" aria-controls=\"content-v0c9\" aria-expanded=\"true\"><div class=\"w-tabs-section-title\">Les urgences en p\u00e9riode COVID<\/div><div class=\"w-tabs-section-control\"><\/div><\/button><div  class=\"w-tabs-section-content us_custom_ea76afbe\" id=\"content-v0c9\"><div class=\"w-tabs-section-content-h i-cf\"><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><p style=\"text-align: justify;\">Le circuit des urgences en oncologie en p\u00e9riode de Pand\u00e9mie\u00a0\u00a0 doit subir une r\u00e9organisation de fa\u00e7on \u00e0 :<\/p>\n<p style=\"text-align: left;\">&#8211; Assurer la s\u00e9curit\u00e9 des patients et du personnel soignant notamment durant les transferts vers les services de radiologie.<br \/>\n&#8211; D\u00e9pister pr\u00e9cocement les patients COVID<br \/>\n&#8211; Continuer \u00e0 prendre en charge correctement les autres complications infectieuses non-COVID<\/p>\n<p style=\"text-align: justify;\">N\u00e9anmoins, parmi\u00a0 toutes les urgences m\u00e9dicales en oncologie deux en particuliers requi\u00e8rent une adaptation de la conduite \u00e0 tenir en p\u00e9riode COVID:<\/p>\n<p style=\"text-align: justify;\"><u>1- La neutrop\u00e9nie f\u00e9brile:<\/u><\/p>\n<p style=\"text-align: justify;\">D\u2019une part, la neutrop\u00e9nie f\u00e9brile est l\u2019une des complications les plus fr\u00e9quentes en oncologie. D\u2019autre part, Liang et al a montr\u00e9 que le fait d\u2019avoir re\u00e7u une chimioth\u00e9rapie durant les 14 jours avant l\u2019admission pour COVID est un facteur aggravant pour la mortalit\u00e9.<\/p>\n<p style=\"text-align: justify;\">Les mesures classiques devant une neutrop\u00e9nie \u00e0 savoir une \u00e9valuation du risque selon le score de la MASCC et la mise sous antibioth\u00e9rapie probabiliste soit par voie intraveineuse soit par voie orale restent standard.<\/p>\n<p style=\"text-align: justify;\">Id\u00e9alement, tous les patients en neutrop\u00e9nie f\u00e9brile devraient b\u00e9n\u00e9ficier d\u2019une PCR COVID m\u00eame en absence de sympt\u00f4mes respiratoires. N\u00e9anmoins, cette mesure semble difficile \u00e0 mettre en place pour des raisons de disponibilit\u00e9 du test. Une alternative int\u00e9ressante serait de r\u00e9aliser un scanner thoracique syst\u00e9matique\u00a0 \u00e9tant donn\u00e9 que Liang et al a d\u00e9montr\u00e9 que les l\u00e9sions de pneumopathie du COVID sont significativement plus fr\u00e9quentes chez les patients atteints de cancer ( 94% versus 74%). Par ailleurs, une attention particuli\u00e8re sera accord\u00e9e \u00e0 la recherche d\u2019une lymphop\u00e9nie quasi-syst\u00e9matique dans le COVID-19.<\/p>\n<p style=\"text-align: justify;\">Le test PCR COVID serait alors r\u00e9alis\u00e9 secondairement chez les patients avec un scanner positif et chez les patients qui ne deviennent pas apyr\u00e9tiques apr\u00e8s 48H<\/p>\n<p style=\"text-align: justify;\"><u>2. L\u2019insuffisance respiratoire:<\/u><\/p>\n<p style=\"text-align: justify;\">La dyspn\u00e9e est un motif fr\u00e9quent de consultation en urgence oncologique. Plusieurs diagnostics sont classiquement \u00e9voqu\u00e9s en fonction du cas clinique du patient:<\/p>\n<ul style=\"text-align: justify;\">\n<li>Les \u00e9panchements pleuraux<\/li>\n<li>Les compressions m\u00e9diastinales<\/li>\n<li>Les insuffisances respiratoires dues \u00e0 des m\u00e9tastases diffuses<\/li>\n<li>Les embolies pulmonaires<\/li>\n<li>Les pneumopathies infectieuses<\/li>\n<li>Les pneumopathies iatrog\u00e8nes<\/li>\n<li>Les cardiopathies<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Classiquement, une radiographie pulmonaire est r\u00e9alis\u00e9e dans un premier temps, suivie d\u2019un scanner thoracique ou d\u2019un angioscanner selon la pr\u00e9sentation clinique.<\/p>\n<p style=\"text-align: justify;\">Il serait judicieux de proposer d\u2019embl\u00e9e un scanner thoracique pour tous les patients, \u00e9tant donn\u00e9 que d\u2019une part le rendement de la radiographie pulmonaire est faible pour les l\u00e9sions COVID et d\u2019autre part que la fi\u00e8vre est un \u00e9l\u00e9ment inconstant chez les patients COVID positifs.<\/p>\n<p style=\"text-align: justify;\">En cas de pr\u00e9sence de l\u00e9sions de pneumopathie qu\u2019elles soient franchement \u00e9vocatrices de COVID ou non, le patient doit b\u00e9n\u00e9ficier d\u2019un test PCR COVID.<\/p>\n<p style=\"text-align: justify;\">Ces deux conduites \u00e0 tenir visent \u00e0 \u00e9viter un diagnostic tardif du COVID chez les patients atteints de cancer et de mettre en route les mesures adapt\u00e9es de fa\u00e7on pr\u00e9coce.<\/p>\n<\/div><\/div><\/div><\/div><\/div><div class=\"w-tabs-section\" id=\"u297\"><button class=\"w-tabs-section-header\" aria-controls=\"content-u297\" aria-expanded=\"false\"><div class=\"w-tabs-section-title\">R\u00e9f\u00e9rences<\/div><div class=\"w-tabs-section-control\"><\/div><\/button><div  class=\"w-tabs-section-content us_custom_71d3e3d1\" id=\"content-u297\"><div class=\"w-tabs-section-content-h i-cf\"><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><ul>\n<li style=\"text-align: justify;\">Liang W, Guan W, Chen R, <em>et al.<\/em> Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. The Lancet Oncology. 2020; <strong>21<\/strong>: 335\u20137.<\/li>\n<li style=\"text-align: left;\">Vidal L, Ben Dor I, Paul M et Al. Oral versus intravenous antibiotic treatment forfebrile\u00a0neutropenia in\u00a0cancer\u00a0 Cochrane Database Syst Rev. 2013\u00a0;9:CD003992.<\/li>\n<li style=\"text-align: justify;\">Kochanek M, Schalk E, von Bergwelt-Baildon M et Al. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol. 2019;98:1051-1069.<\/li>\n<li style=\"text-align: justify;\">Ahn S, Lee Y-S. Predictive factors for poor prognosis febrile neutropenia.\u00a0Curr Opin Oncol.\u00a02012;24:376\u2013380.<\/li>\n<\/ul>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"ult-spacer spacer-69f4102da865a\" data-id=\"69f4102da865a\" data-height=\"35\" data-height-mobile=\"35\" data-height-tab=\"35\" data-height-tab-portrait=\"\" data-height-mobile-landscape=\"\" style=\"clear:both;display:block;\"><\/div><div class=\"g-cols wpb_row us_custom_60e9caca us_animate_this via_grid cols_1 laptops-cols_inherit tablets-cols_inherit mobiles-cols_1 valign_top type_default stacking_default\" style=\"--columns-gap:3rem;\"><div class=\"wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"w-text us_custom_7ccf62ca has_text_color\"><span class=\"w-text-h\"><span class=\"w-text-value\">PARTENAIRES<\/span><\/span><\/div><\/div><\/div><\/div><div class=\"w-image align_center\"><div class=\"w-image-h\"><img decoding=\"async\" width=\"1300\" height=\"231\" src=\"https:\/\/onetech.dev\/covid\/data\/partenaire.png\" class=\"attachment-full size-full\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/onetech.dev\/covid\/data\/partenaire.png 1300w, https:\/\/onetech.dev\/covid\/data\/partenaire-300x53.png 300w, https:\/\/onetech.dev\/covid\/data\/partenaire-1024x182.png 1024w, https:\/\/onetech.dev\/covid\/data\/partenaire-150x27.png 150w\" sizes=\"auto, (max-width: 1300px) 100vw, 1300px\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/section>\n","protected":false},"excerpt":{"rendered":"RECOMMANDATIONS G\u00c9N\u00c9RALES Urgences RetourLes urgences en p\u00e9riode COVID Le circuit des urgences en oncologie en p\u00e9riode de Pand\u00e9mie\u00a0\u00a0 doit subir une r\u00e9organisation de fa\u00e7on \u00e0 : &#8211; Assurer la s\u00e9curit\u00e9 des patients et du personnel soignant notamment durant les transferts vers les services de radiologie. &#8211; D\u00e9pister pr\u00e9cocement les patients COVID &#8211; Continuer \u00e0 prendre...","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-142","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/onetech.dev\/covid\/wp-json\/wp\/v2\/pages\/142","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/onetech.dev\/covid\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/onetech.dev\/covid\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/onetech.dev\/covid\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/onetech.dev\/covid\/wp-json\/wp\/v2\/comments?post=142"}],"version-history":[{"count":1,"href":"https:\/\/onetech.dev\/covid\/wp-json\/wp\/v2\/pages\/142\/revisions"}],"predecessor-version":[{"id":143,"href":"https:\/\/onetech.dev\/covid\/wp-json\/wp\/v2\/pages\/142\/revisions\/143"}],"wp:attachment":[{"href":"https:\/\/onetech.dev\/covid\/wp-json\/wp\/v2\/media?parent=142"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}