[Is it necessary to revalue the risk of a gas embolism complicating an intervention with carbon dioxide insufflation?]. / Faut-il réévaluer le risque d'une embolie gazeuse compliquant une intervention avec insufflation de gaz carbonique?

Due to the characteristics of the carbon dioxide, gas embolism occurring during coelioscopy using this gas is usually considered as non critical. We report three observations of gas embolism which have occurred during laparoscopic surgery, one mild and two having led to death in spite of hyperbaric oxygen therapy. These observations prompted us to reevaluate the role of carbon dioxide in the severity of gas embolism.

[Prehospital management of very elderly patients with ST segment elevation in Paris by mobile intensive care units (Samu)]. / Prise en charge par le Samu de l'infarctus du myocarde avec sus-décalage du segment ST en milieu urbain chez le sujet agé de plus de 80 ans.

More and more elderly people are hospitalised with myocardial infarction. Little is known on their pre-hospital management. In 2001 and 2002, 105 patients aged 80 years or more with suspected ST elevation infarction were managed by the mobile intensive care unit system of the SAMU de Paris-Necker. Diagnosis of infarction was confirmed in 92 (88%). Over 60% of the patients were women. Median time delay from symptom onset to call to the emergency service was 127 minutes, longer in nonagenarians (175 vs 101 minutes). Prehospital use of aspirin was 81% and 39% received an intravenous bolus of heparin. A reperfusion strategy was decided in only 30% (primary PCI: 23/26). One-month mortality was 21% and was related to older age, time when the call to the Samu was made, and absence of current smoking. Overall, the prehospital management of very elderly patients with suspected ST elevation infarction appears far from optimal.