L'article suivant parle du transport de malades souffrant de problèmes cardiaques aigüs vers les mauvais CH, à savoir des CH qui n'ont pas de salles de cathétérisme cardiaque.
L'article ajoute de plus que le cathétérisme précoce résulte en un taux de mortalité après 30 jours de près de 50 %, ce qui n'est pas négligeable. Devrait-on faire un transport plus long vers un CH avec une salle de cathétérisme en devoir 24heures? La trombolyse en préhospitalier, suivi du cathétérisme d'urgence serait-elle une possibilité pour diminuer le taux de mortalité des infarctus (qui demeure à 50% dans la première heure, si ma mémoire est bonne).(Charles, Michel, les autres, vous avez qq chose à ce sujet?) D'où l'importance de pouvoir au moins faire un 12-15-18 dérivations en préhospitalier, même au Québec. Salutations Stéphan Gascon > > New York Times, December 3, 2002 > > Playing Ambulance Roulette > By SANDEEP JAUHAR, M.D. and NORMA KELLER, M.D. > > A middle-aged man collapses on a Manhattan subway > platform with a > heart attack. Paramedics arrive, and they do all the > right things: > give him an aspirin to chew, place nitroglycerin > under his tongue and > administer oxygen through a face mask. > > Then they take him to a hospital that doesn't > perform angioplasty, > the procedure that uses tiny balloons and coils of > wire called stents > to open blockages in the arteries that feed the > heart. Angioplasty is > the best treatment for a heart attack if performed > expeditiously by > experienced doctors. > > Instead, the man receives a clot-dissolving drug - a > thrombolytic - > which in his case doesn't work. > > By the time the man is transferred to our hospital > for angioplasty, > it is too late. He is already exhibiting signs of > heart failure. At > this point there is little reason for us to open his > blocked coronary > artery, because the part of his heart that is fed by > the artery is > already dead. > > The story of this patient is one we as doctors > encounter almost every > day: a heart attack victim taken by ambulance to a > hospital that > isn't equipped to perform angioplasty. > > If the man had been taken to one of the six > Manhattan hospitals that > have cardiac catheterization, where angioplasty is > performed, open 24 > hours a day, the damage to his heart could have been > averted, adding > years to his life. But it would have required a > degree of > coordination and oversight that many ambulance > fleets in New York and > across the country lack. > > Several recently published studies have sparked a > vigorous debate > over how acute heart attacks, the quintessential > medical emergency, > should be treated. > > With a million cases in the United States every > year, acute heart > attacks are a major public health problem, and how > this debate is > settled is bound to have important public health > implications. > > When heart muscle is deprived of blood, it goes > through what has been > termed the "ischemic cascade." Initially the muscle > goes into a sort > of hibernating state, stunned by a lack of oxygen. > Cells swell as > sodium and calcium flow in through suddenly porous > membranes, > creating havoc with the cellular machinery. > > At this point, the damage is usually reversible. But > with prolonged > oxygen deprivation for many minutes, cells start to > die. > > Studies comparing angioplasty and thrombolysis have > shown a clear > advantage for angioplasty if it is performed by an > experienced > cardiologist in a high-volume catheterization lab > within three hours > of the onset of symptoms. > > Death rates after 30 days are lower by almost 50 > percent. Also, > angioplasty results in an open coronary artery 90 > percent of the > time, compared with 54 percent for thrombolytic > drugs. > > In addition, angioplasty drastically reduces > bleeding complications, > especially in the brain, and it allows patients to > spend fewer days > in the hospital. > > But whether these advantages could be maintained in > the real world, > where delay in getting patients to catheterization > labs is > inevitable, had been an open question. > > Then, in March, a Danish study first presented at > the American > College of Cardiology meeting notched another > victory for angioplasty. > > In the study, 1,572 patients who were admitted to > community hospitals > with acute heart attacks were randomly given > thrombolytic treatment > or transferred by ambulance to angioplasty centers > up to 100 miles > away. > > Angioplasty resulted in a 40 percent reduction in > death, recurrent > heart attack or stroke after 30 days. The data were > compelling enough > that the study was stopped early by a data > monitoring committee. > > In a related study published in April in The Journal > of the American > Medical Association, 451 patients at 11 community > hospitals in > Maryland and Massachusetts were randomly assigned to > receive > thrombolytic therapy or angioplasty. > > Angioplasty has traditionally been performed only at > hospitals with > cardiac surgeons on duty, in case there are > complications, but these > relatively small hospitals had none. > > In following up, the study found that even without > surgical backup, > angioplasty reduced the occurrence of heart attacks > and strokes in > the next six month by almost 40 percent and > shortened hospital stays > for the original visit by an average of a day and a > half. > > Coordinating ambulance fleets in major cities is a > gargantuan task, > in part because a large number - 30 percent in New > York City, for > example - are privately owned. But paramedics have > already learned to > take trauma and burn victims to specialized > hospitals. Heart attack > victims deserve no less, and many more lives are at > stake. ______________________________________________________________________ Post your free ad now! http://personals.yahoo.ca --- SMU-L Le petit compendium 2003 - Guide de reference sur les medicaments en comprimes et par inhalation (+ de 1150 medicaments; reference C.P.S. 2003). Cout: $10.00 l'unite, $1.00 sera remis a une fondation pour enfants malades. Courriel: [EMAIL PROTECTED] Site web: www.urgence.qc.ca/compendium
