[The first our quintet or the channel of care for the most usual urgent pathologies].
The European Community has named five emergencies as being priorities. These five emergencies are: the cardiorespiratory arrest, the myocardial infarction, the severe polytrauma, the cerebral vascular accident and the severe acute dyspnoea. In this article three of them are discussed. Seen with the eyes of a generalist the severe polytrauma requires simple gestures, such as an early call for help by the SMUR, axialisation of head, trunk and members, compression of overtly sources of bleeding and opening the airway to facilitate breathing. The acute myocardial infarction continues to pose problems of diagnosis. The pathognomonic presentations are the STEMI and the N-STEMI infarction. In these cases it is a priority to call for the help of a SMUR unit. In the case of a STEMI infarction it is an absolute priority to admit the patient quickly to hospital and to directly move on to the coronarography ward for a primary angioplasty procedure. Within the first three hours of the infarction, if primary angioplasty is not a possibility within the first 90 minutes, thrombolysis is absolutely indicated. In the case of N-STEMI infarction a quick admission to a coronary care unit is urgent but the treatment is mainly medical. The cerebral vascular incident occurs more frequently than the myocardial infarction, but, culturally, not enough importance is attached to this pathology. Within the first three hours the aim is to get the patient to an emergency department (by means of the SMUR), to evaluate the coagulation values of the patient and to perform a head scan (without the injection of contrast) of good quality. If the patient is not too severely incapacitated (NIH score between 4 and 25), if the head scan does not show a hemorrhagic lesion and if there is no contraindication for thrombolysis, Actilyse should be administered. The time it takes to do all of these acts can not exceed the above mentioned three hours.
Claessens
B
B
Service des Urgences et du SMUR, C.H.U. Saint-Pierre, Bruxelles.
Jacques
J M
JM
Polikipis
M
M
Coenen
F
F
Tadjer
S
S
Baillon
R
R
Stevens
E
E
Vandenbossche
J L
JL
Gazagne
M D
MD
Dechamps
P
P
Mols
P
P
D004417:Dyspnea / Q000453:epidemiology / Q000628:therapy*; D004630:Emergencies; D004632:Emergency Medical Services; D005062:European Union; D006323:Heart Arrest / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy*