Asunto(s)
Deshidratación/terapia , Tratamiento de Urgencia/métodos , Fluidoterapia/métodos , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Deshidratación/diagnóstico , Deshidratación/etiología , Tratamiento de Urgencia/enfermería , Femenino , Fluidoterapia/enfermería , Humanos , Factores de RiesgoAsunto(s)
Primeros Auxilios/métodos , Mordeduras de Serpientes/terapia , Viperidae , Animales , Documentación , Servicios Médicos de Urgencia/métodos , Hospitalización , Humanos , Índice de Severidad de la Enfermedad , Mordeduras de Serpientes/clasificación , Mordeduras de Serpientes/diagnóstico , Mordeduras de Serpientes/etiologíaRESUMEN
Percutaneous transluminal coronary angioplasty (PTCA) is an alternative to fibrinolysis in the treatment of acute myocardial infarction (AMI). However, after balloon PTCA, the rate of early re-occlusion, of re-infarctus and of restenosis remains high. Stent implantation with antiplatelet drug regimen (aspirin, ticlid) limits these risks. Abciximab (new GPIIb/IIIa receptors inhibitor) reduces PTCA complications rate in the acute coronary syndromes. Intravenous administration of abciximab can restore a normal flow in the infarcted related coronary artery (IRA) after few minutes. A monocentric, non randomized, prospective pilot study was iniated to assess the feasibility of pre-hospital treatment with abciximab in preparation to primary PTCA stenting in AMI (primary endpoint) and to appreciate potential benefits in initial IRA patency as well as prevention of PTCA thrombotic complications (secondary endpoint). Between April 1997 and January 1998, 38 AMI were treated with abciximab in pre-hospital phase (group A). Mobil Intensive Care Unit (MICU) team implemented the treatment and guaranteed immediate transport to the cathlab (abciximab bolus-coronary angiography time = 37 +/- 17 min). Immediate results were compared to those of 198 paired patients who were treated for AMI during the same period (Group T). Initial IRA flow TIMI grade 3 was significantly higher in group A, 24%, than in group T, 9% (p < 0.017). The rates of per-procedural complications (no flow, distal embolism), of local complications, of transfusions were not significantly different. During 1 month follow-up, there was no significant difference between group A and group T concerning death, re-MI, stent thrombosis and new revascularization. To conclude, the pre-hospital treatment with abciximab in AMI is feasible by MICU medical team without any delay of the cathlab admission. It is associated with no increased hemorrhagic complications rate. The abciximab pre-hospital treatment improves the initial IRA patency. These encouraging preliminary results expect to be confirmed by larger, multicentric, randomized and prospective studies.
Asunto(s)
Angioplastia Coronaria con Balón , Anticuerpos Monoclonales/uso terapéutico , Anticoagulantes/uso terapéutico , Fragmentos Fab de Inmunoglobulinas/uso terapéutico , Infarto del Miocardio/terapia , Abciximab , Enfermedad Aguda , Anticuerpos Monoclonales/farmacología , Anticoagulantes/farmacología , Femenino , Estudios de Seguimiento , Humanos , Fragmentos Fab de Inmunoglobulinas/farmacología , Masculino , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Reanimación Cardiopulmonar/métodos , Reanimación Cardiopulmonar/enfermería , Enfermería de Urgencia/métodos , Insuficiencia Respiratoria/enfermería , Adulto , Analgésicos Opioides/envenenamiento , Ansiolíticos/envenenamiento , Dextropropoxifeno/envenenamiento , Flunitrazepam/envenenamiento , Humanos , Masculino , Insuficiencia Respiratoria/inducido químicamenteRESUMEN
A renewal of interest in the intraosseous route has appeared lately in France. It concerns pediatric patients. After anatomophysiological and technical quotes, we report the indications, contraindications, method of supervision and complications of the placement of an intraosseous infusion. Our modest experience enables us to present three observations where intraosseous route has been used outside hospital in children suffering a cardiopulmonary arrest on arrival of the practitioner belonging to the mobile emergency unit. This rapid and easy to place technique seems to be attractive as an alternative to the intravenous route in situations of utmost emergency, this all the more so since there are few reported contraindications and complications.