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Das Angioödem in der Notaufnahme

Angioedema in the emergency department

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Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Akute Angioödeme können potenziell lebensbedrohlich verlaufen. Die vor allem im Kopf-Hals-Bereich auftretenden Schwellungen können in mastzellmediatorvermittelte und bradykininvermittelte Formen unterteilt werden. Die Unterscheidung ist aufgrund der unterschiedlichen therapeutischen Strategien essenziell, wobei im Zweifelsfall immer ein Therapieversuch mit Adrenalin, Antihistaminika und Glukokortikoiden durchgeführt werden sollte. Für die hereditären Angioödeme existiert eine spezifische Therapie, bei medikamentenassoziierten Formen ist der umgehende und lebenslange Stopp der Medikation entscheidend. In der Notfallsituation kann die Diagnose ausschließlich aufgrund von Anamnese und klinischen Symptomen gestellt werden. Die Erkennung einer drohenden Atemwegsverlegung und die Sicherung des Atemwegs hat die höchste Priorität.

Abstract

Acute angioedema is mostly found in the head and neck region. Therefore, it can be life threatening by potentially endangering air way patency. Pathophysiologically angioedemas can be divided into mast cell-mediated or bradykinin-mediated forms. Differentiation is essential due to the different therapeutic strategies. In cases of doubt, initial therapy with adrenalin, antihistamines, and glucocorticoids should be initiated. This initial emergency treatment is comparable to the treatment of allergic reactions. For diagnosed or suspected hereditary angioedema, specific treatments are available. For drug-associated forms, immediate and life-long cessation of the medication is crucial. In the emergency situation, diagnosis can only be based on medical history and clinical symptoms. Recognition of impending airway obstruction and securing the airway is of highest priority; final diagnosis must be confirmed later.

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Authors and Affiliations

  1. Zentrum für Notfall- und Rettungsmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland

    Laura Bühler & Bonaventura Schmid

  2. Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland

    Elisabeth Fabritius & Tanja Daniela Grauvogel

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  1. Laura Bühler
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  2. Bonaventura Schmid
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  3. Elisabeth Fabritius
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  4. Tanja Daniela Grauvogel
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Correspondence to Laura Bühler.

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L. Bühler, B. Schmid, E. Fabritius und T.D. Grauvogel geben an, dass kein Interessenkonflikt besteht.

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Bühler, L., Schmid, B., Fabritius, E. et al. Das Angioödem in der Notaufnahme. Med Klin Intensivmed Notfmed 118, 4–13 (2023). https://doi.org/10.1007/s00063-022-00983-9

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  • DOI: https://doi.org/10.1007/s00063-022-00983-9

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