Notfall + Rettungsmedizin

, Volume 10, Issue 5, pp 343–349

Akutes Koronarsyndrom

Prozessmanagement in der Notaufnahme
Leitthema

Zusammenfassung

Das akute Koronarsyndrom stellt für den Alltag der Notaufnahme eine große Herausforderung dar. Problematisch ist einerseits die sichere Einschätzung des Hochrisikopatienten mit oder ohne Myokardinfarkt, der als solcher erkannt, überwacht und in Abhängigkeit seiner Beschwerden und Befunde möglicherweise rasch einer Reperfusionstherapie zugeführt werden muss. Andererseits zeigen Daten aber auch, dass 2–5% aller Koronarsyndrome in der Notaufnahme übersehen werden. Dies belegt, dass die Erkennung des Niedrigrisikopatienten und seine zuverlässige Entlassfähigkeit aus der Notaufnahme ebenfalls große Schwierigkeiten bereiten. Einstimmig schlagen die Fachgesellschaften eine Risikostratifizierung nach prognostischen Parametern vor, zu denen Anamnese, klinische Befunde, 12-Kanal-EKG und laborchemische Biomarker gehören. Nach den Daten dieser Leitlinien bzw. der speziellen Literatur lassen sich 4 Risikogruppen mit den jeweils diagnostisch und therapeutisch notwendigen Handlungsabläufen definieren, die ein breites Spektrum an Strategien – von umgehender Reperfusionstherapie über Monitoring bis zur Klärung der Entlassfähigkeit – umfassen. Auch die Differenzialdiagnose des Koronarsyndroms muss nach prognostischen Kriterien erhoben und gewichtet werden.

Schlüsselwörter

Notaufnahme Koronarsyndrom Reperfusionstherapie Risikostratifizierung Thoraxschmerz 

Acute coronary syndrome: Process management in the emergency room

Abstract

Acute coronary syndrome continues to be a daily challenge for the emergency room. It is problematic to clearly determine a high risk patient, with or without myocardial infarct, who must be observed and, dependently of symptoms and findings, possibly undergo rapid reperfusion therapy. On the other hand, data show that 2–5% of all coronary syndrome patients in the emergency room are overlooked. This indicates that the recognition of low risk patients and their potential to be discharged from the emergency room also provide considerable difficulties. Specialist societies are unanimously recommending risk stratification based on prognostic parameters which include anamnesis, clinical findings, 12 channel EKG and laboratory determined chemical biomarkers. Based on the data from these guidelines and the specialist literature, four risk groups with the required diagnostic and therapeutic measures have been defined. These include a broad spectrum of strategies from immediate reperfusion therapy over monitoring to determination of the potential for discharge. The differential diagnosis of coronary syndrome must also be determined and evaluated using prognostic criteria.

Keywords

Emergency room Coronary syndrome Reperfusion therapy Risk stratification Chest pain 

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.I. Medizinische Klinik, Zentrale NotaufnahmeUniversitätsklinikum MannheimMannheimDeutschland

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