Les médecins exerçant dans le service des urgences d’une façon permanente ou non doivent prendre an charge des pathologies diversifiées et souvent complexes. Le pronostic vital laisse parfois peu de temps pour une analyse complète de la symptomatologie clinique. Ainsi dans de nombreux cas, des examens complémentaires justifiés ou non sont demandés surtout par les jeunes médecins pour plus de sécurité. Cette démarche excessive entraîne sûrement un surcoût de dépense de santé et peut être un raisonnement erroné.
MATERIEL ET METHODE
:Il s’agit d’une étude prospective réalisée dans le service des urgences aux cours de l’année 2003, composée de 2 parties :
Analyser l apport de 3 examens les plus demandes aux urgences à Savoir radiographie du thorax, électrocardiogramme, enzymes cardiaques.
Évaluer l’intérêt diagnostique de NT-pro BNP dans les dyspnées aigues au service des urgences.
DISCUSSION :
La prescription d’un examen paraclinique est un art difficile qui requiert un savoir-faire qui ne doit rien à l’intuition ni aux rituels. Dans le cadre particulier de l’urgence, la prescription – plus que dans d’autres domaines – doit répondre à des impératifs de moyens et non de résultats. L’objectif de la prescription doit être clair. Un marqueur biologique est utile en urgence si une question urgente concernant la maladie ou le malade mérite d’être posée et si le marqueur y répond de façon performante.
Il n’a pas d’intérêt si la question est mal posée, si l’examen demande n’est pas adapté ou si la réponse apportée était évidente. En effet, un examen complémentaire ne donne pas de bonne réponse à une question mal posée ou s’il n’est pas adapté à la question, et n’offre qu’une réponse inutile à une question qui ne se pose pas.
CONCLUSION :
Le bilan complémentaire aux urgences doit permettre d’améliorer le diagnostic, de préciser le terrain et/ou de stratifier la gravité d’un malade.
le BNP permet d’améliorer la morbidité des patients admis pour dyspnée aiguë. Compte tenu de l’intérêt pronostique de la précocité du diagnostic d’ICA, le dosage rapide du BNP ou du NT-pro BNP devrait être accessible 24 heures sur 24 en urgence.
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