ABSTRACT
The Swiss rescue system is based on a collaboration of two trades (ambulance and emergency physician). Paramedic provide independent support for most urgent medical situations under the cover of three years of training and a medical delegation. For more complex situations, the prehospital physician retains his place (triage, severe trauma, airway management, respiratory distress, medico-legal emergencies, specialized procedures or exceptional situations). This collaboration is the foundation of the Swiss prehospital system. One does not go without the other.
Le système de secours suisse est basé sur une collaboration de deux corps de métiers (ambulanciers et médecins d'urgence). L'ambulancier assure la prise en charge en autonomie de la plupart des situations médicales urgentes sous couvert d'une formation de 3 années et d'une délégation médicale. Pour des situations plus complexes, le médecin préhospitalier conserve sa place (triage, traumatologie grave, gestion des voies aériennes, détresses respiratoires, urgences médico-légales, procédures spécialisées ou situations sanitaires exceptionnelles). Cette collaboration est le socle du système préhospitalier suisse. L'un ne va pas sans l'autre.
Subject(s)
Emergency Medical Services , Physicians , Ambulances , Emergencies , Humans , TriageABSTRACT
The purpose of this article is to review the main airway devices available to the emergency physician in a prehospital setting. Since the risk of difficult intubation is increased under pre-hospital conditions; the emergency physician should be aware of alternatives to direct tracheal intubation such as supraglottic devices, video laryngoscopes and cricothyroidotomy. These different techniques and devices must be integrated into a strategy for the management of the upper airway. We propose a prehospital airways algorithm adapted from the Latin Airway Foundation (FLAVA).
L'objectif de cet article est de passer en revue les principaux dispositifs de gestion des voies aériennes à disposition du médecin d'urgence. Le risque d'intubation difficile étant majoré dans les conditions d'intervention préhospitalière, le médecin d'urgence doit connaître les alternatives à l'intubation trachéale par laryngoscopie directe telles que les dispositifs supraglottiques, les vidéolaryngoscopes et la cricothyroïdotomie. Ces différentes techniques et dispositifs doivent être intégrés dans une stratégie de gestion des voies aériennes supérieures. Nous proposons un algorithme adapté pour le préhospitalier inspiré de celui de la Fondation latine des voies aériennes (FLAVA).
Subject(s)
Emergency Medical Services/methods , Intubation, Intratracheal/instrumentation , Intubation, Intratracheal/methods , Airway Management , Humans , Laryngoscopes , Laryngoscopy , TracheaABSTRACT
BACKGROUND: Data from randomized controlled trials have shown that the ABSORB BVS is non-inferior to Cobalt Chromium everolimus-eluting stents at 2years. METHODS & RESULTS: The EVERBIO II trial (Comparison of Everolimus- and Biolimus-Eluting Coronary Stents with Everolimus-Eluting Bioresorbable Vascular Scaffold) is a single-center, assessor-blind, randomized controlled trial enrolling 240 patients with an allocation ration of 1:1:1 conducted at University and Hospital Fribourg, Switzerland. The studied devices were an everolimus-eluting persistent polymer stent (EES), a biolimus-eluting stent with bioabsorbable polymer (BES) and a fully bioresorbable vascular scaffold (BVS). Clinical end points collected at 9months, 12months, and 2years, were academic research consortium defined composites, device thrombosis and target-vessel revascularization. Clinical follow-up at 2years was available in 96% (N=77) of patients in the EES group, in 100% (N=80) in the BES and 99% (N=77) in the BVS group. The device-oriented composite end point of cardiac death, target-vessel myocardial infarction and target-lesion revascularization occurred in 13 (16%) patients treated with EES, in 7 (9%) patients treated with BES and in 16 (21%) patients treated with BVS. There was no significant difference when the metallic stents were compared to the BVS (p=0.12). There was one late scaffold thrombosis throughout the trial in the BVS group, and no definite stent thrombosis in either EES or BES treated patients. CONCLUSIONS: The current analysis shows no significant differences with regard to clinical outcomes at 2years between BVS and the best-in-class metallic DES. Event rates were numerically higher in BVS-treated patients. However, when BVS were compared to BES alone, the occurrence of device related adverse events was significantly increased.
