Presse Med
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Cardiac arrest is a public health issue for which international guidelines are updated every five years (last bringing up to date on 2010 october). The lake of epidemiologic data on cardiac arrest justifies the building of a national register. ⋯ Our national register "RéAC"is planned to deploy the present year for out-of-hospital cardiac arrest with the help of our scientific societies and the Department of Health. It is integrated in a program of evaluation and improvement of professional practices for physicians and prehospital teams who will be involved in its exhaustive use.
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The prevalence of diabetes is rising and diabetics may soon represent more than 5% of the world population. The type 2 diabetes is a major independent risk factor for coronary artery disease. The screening for silent myocardial ischemia (IMS) must be systematic. ⋯ To avoid hypoglycemia, blood glucose concentration less than 11 mmol. L(-1)(2g. L(-1)) seems a reasonable target during and after surgery.
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Thienopyridines have become the cornerstone of treatment of percutaneous coronary intervention although no survival benefit has ever been shown with clopidogrel despite increasing loading doses. Newly developed P2Y(12) inhibitors are more potent, more predictable and have a faster onset of action than clopidogrel, characteristics that make them particularly attractive for high-risk PCI. Four new P2Y(12) inhibitors have been tested each of them having particular individual properties. ⋯ The effect of these new compounds is prompt, predictable and powerful as compared to clopidogrel. Their net benefit is particularly marked in PCI for STEMI patients, in which there is no significant increase in major bleeding when compared with clopidogrel. However, because in clinical trials patients perceived to be at higher risk for bleeding usually are excluded, the risk of major and even fatal bleeding might even be higher in a "real-world" setting i.e. in the elderly patient with comorbidities.
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A procedure for telephone CPR must be started since the call centres do the diagnosis of cardiac arrest. All the rescuers, trained or not, have to realize quality chest compressions (depths 5 in 6cm, rhythm from 100 to 120 per minute) to the victims of cardiac arrest. Chest compressions must be interrupted only briefly in case of indispensable specific interventions. ⋯ If the intravenous access cannot be used, it is the intra-osseous, which would be privileged. In case of children cardiac arrest, the non-professional rescuer have to use a ratio of 30 compressions for two ventilations if he is alone and 15/2 if they are working in team. All the citizens, and all the healthcare providers, should be trained in CPR and to keep their skills should follow all three to six months refresher courses to upgrade their knowledge.