Revue médicale suisse
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In the last fifteen years, procalcitonin measurement has been evaluated as a rapid diagnostic aid for suspected infection. Procalcitonin is now widely used in any febrile patient despite the lack of evidence supporting that practice. ⋯ Procalcitonin has been assessed in the emergency department in patients with lower respiratory tract infections and in patients admitted for an acute febrile illness. Results are encouraging but preliminary, therefore procalcitonine measurement should be restricted to patients with criteria of severe infection for the time being.
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Revue médicale suisse · Sep 2007
[Some consequences of the application of the new Swiss penal code on legal psychiatry].
The new text of the Swiss penal code, which entered into effect at the beginning of 2007, has many incidences on the practice of the psychiatrists realizing expertises in the penal field or engaged in the application of legal measures imposing a treatment. The most notable consequences of this text are, on the one hand, a new definition of the concept of penal irresponsibility which is not necessarily any more related to a psychiatric diagnosis and, on the other hand, a new definition of legal constraints that justice can take to prevent new punishable acts and which appreciably modifies the place of the psychiatrists in the questions binding psychiatric care and social control.
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Revue médicale suisse · Sep 2007
Review[Antihypertensive therapy according to the ESH/ESC guidelines].
The guidelines of the European society of hypertension and the European society of cardiology have been updated. With regard to antihypertensive treatment, diuretics, beta-blockers, calcium antagonists, angiotensin converting enzyme inhibitors and angiotensin II antagonists are still considered as first line options. Treatment may also be initiated using a fixed dose combination containing two agents lowering blood pressure by different mechanisms. This is particularly true in patients with systolic blood pressure > 160 mmHg and/ or diastolic blood pressure >90 mmHg, as well as in those with high cardiovascular risk.
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Revue médicale suisse · Aug 2007
Review[Initial management of acute heart failure in the emergency department].
Acute decompensated heart failure is one of the most leading diseases among elderly patients presenting in the emergency department with a chief complaint of dyspnea. Initial management is crucial for the patient's outcome. In this article we propose a review of diagnosis, treatment, stratification and orientation of patients admitted to emergency department with acute heart failure in light of recent recommendations.
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Revue médicale suisse · Aug 2007
Review[Agitation in prehospital setting: view of emergency physicians].
Agitation is a behavioral emergency that can have numerous underlying causes, organic as well as psychiatric. The presence of a clinician and well-trained staff determine the quality of care, thus facilitating the dialog with the patient and, if needed, ensuring the safe application of medication and physical restraint. ⋯ When necessary, medication and restraint should be applied, in order to enable medical evaluation of a patient. Calming without sedation seems the most advised endpoint of intervention, according to expert-opinion.