Presse Med
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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.
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Prescription of medicines by telephone (PMT) in the call Center 15 is a reality, but has never been studied. ⋯ The PMT at the center 15 is realized in one third of cases. This work helps highlight the shortcomings of the practice in terms of safety and security requirement of the proceedings against the recommendations of the French High Authority for Health.