[Acute pulmonary embolism : about paradox, judgments and evidences]. / Embolie pulmonaire aiguë : paradoxes, jugements et évidences.

Pulmonary embolism (PE) is the third most common cardiovascular disease in industrialized countries. Multiple clinical presentations and non-specific symptoms lead to frequents misdiagnosis. Using and plan therapeutic and admission versus discharge strategies.

L'embolie pulmonaire (EP) représente la troisième maladie cardiovasculaire dans les pays industrialisés. Les diverses présentations cliniques et les signes d'appel aspécifiques rendent le diagnostic parfois difficile. L'utilisation de scores prédictifs permet d'aider le clinicien dans la mise au point diagnostique, l'évaluation du risque, la stratégie thérapeutique et la décision d'admettre ou non le patient à l'hôpital.

[Psychological impact of out-of-hospital cardiopulmonary resuscitation (CPR) on the witness engaged in gestures of survival]. / Impact psychologique de la réanimation cardio-pulmonaire en extra-hospitalier (ACREH) chez le témoin pratiquant les gestes de survie.

The occurrence of an unexpected sudden death puts the witnesses of this event in a situation of high emotional impact. The benefit to allow the families of victims to dispense the first resuscitation techniques has been emphasized. However, little data exist on the emotional impact of a cardio-respiratory arrest outside the hospital on the witness, who is often a close family member. Recently, we investigated the presence of psychological distress and the factors influencing it, in the active practice of basic resuscitation gestures by the witnesses guided by the operator 112. Resuscitation by a person not belonging to the medical corps seems not to be devoid of psychological impact. Indeed, the presence of psychological distress is observed for most of witnesses questioned 6 to 10 days after the call but also 3 months later. This work highlights therefore the importance of identifying the coping strategies involved, in order to promote potentially beneficial strategies and limit the trauma associated with this type of event.

La survenue d'une mort subite plonge les témoins directs de cet événement dans une situation à haut impact émotionnel. Le bénéfice de laisser les familles des victimes assister aux manœuvres de réanimation a été souligné. Cependant, peu de données existent sur l'impact émotionnel d'un arrêt cardio-respiratoire en dehors de l'hôpital sur le témoin, qui est principalement un proche de la famille. Récemment, nous nous sommes interrogés sur l'induction potentielle d'une détresse psychologique, et les facteurs influençant celle-ci, dans la pratique active des gestes de réanimation de base par le témoin direct, guidé par l'opérateur 112. L'application des gestes de réanimation par une personne n'appartenant pas au corps médical semble ne pas être dénué d'impact. En effet, la présence d'une détresse psychologique chez la plupart des témoins, questionnés 6 à 10 jours après l'appel et 3 mois plus tard, est observée. Ce travail objective donc l'importance d'identifier les stratégies d'adaptation en jeu, afin de favoriser les stratégies potentiellement bénéfiques et de limiter le traumatisme lié à ce type d'événement.

[How I treat ... out-of-hospital cardiac arrest. The role of the emergency medical dispatcher]. / Comment je traite ... l'arrêt cardio-respiratoire extrahospitalier: la fenêtre du centraliste 112.

Sudden cardiac arrest is an event associated with a very low survival rate. The latter is inversely proportional to the duration of the cardiovascular arrest. The chain of survival concept is a sequence of 4 events to be carried out as fast as possible with a view to ensure the patient's survival. This sequence consists of early access to and activation of the emergency medical system, early initiation of basic cardiopulmonary resuscitation, early defibrillation and early specialized care. The number of potential witnesses trained in Basic Life Support (BLS) does not guarantee an adequate basic resuscitation before the arrival of medical aid. In order to optimize the management of victims and callers, the concept of dispatching-assisted cardiopulmonary resuscitation based on a structured protocol has been implemented. The implementation of this plan to improve the quality of call handling required training and assessment of impacts on beneficiaries. The research datashow a reduction of the duration of cardiac arrest, an increase in resuscitation initiated by a witness, an improved survival rate, and a decreased stress and unanimous approval of dispatchers. Currently, the process is being improved and sustained.

Commissioning Siemens Virtual Wedges in the Oncentra MasterPlan treatment planning system using Gafchromic EBT film.

PURPOSE: Virtual Wedges were introduced in Siemens LINACs to improve the treatment workflow. The aim of the present work is the validation of dose calculation by MasterPlan-Oncentra treatment planning system for virtual wedged beams. METHODS: The Oncor Siemens accelerator installed in the authors' department produces 6 and 15 MV photon beams. At first, the consistency of VW LINAC production was tested and the EBT film measuring method was verified. This method is based on the scanner uniformity correction and absolute dose calibration as reported in literature. Then, the measured and calculated wedge factors and beam profiles are compared. For 15 degrees, 30 degrees, 45 degrees, and 60 degrees wedge angles, the wedge factors for different field sizes were measured by an ionization chamber and the dose profiles were acquired by Gafchromic EBT film. Both types of measurements were collected in isocentric condition. RESULTS: The comparison between measured and calculated VW factors shows discrepancies that increase with field size and angle. The OTP Enhanced algorithm produces better agreement with measurements than the Classic one, with improvement overall visible for large angles. The agreement between measured and planned beam profiles is within limits reported by the ESTRO Booklet No. 7 in terms of confidence limits. CONCLUSIONS: The MasterPlan-Oncentra treatment planning system determines wedge factors and VW profiles within the requested accuracy in the majority of treatment conditions. For big field dimensions and wedge angle, wedge factor accordance was worse, but it may be increased with an improvement of the LINAC dosimetric board calibration.