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Schlaganfallversorgung in der Prähospitalphase

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Book cover Die Notfalltherapie und Intensivtherapie bei Schlaganfall

Summary

In the Western industrialized nations, stroke is the third leading cause of death and the number one cause of acquired disability. To optimize the therapeutic options available to these patients, early signs of stroke need to be recognized and treatment has to be initiated within 3 hours from symptom onset. A „chain of stroke-management“ consisting of an early diagnosis and rapid prehospital treatment, efficient diagnostic procedures, and subsequent initiation of acute therapy is required. This article provides an overview of this approach. Focus is directed at the prehospital phase because, in contrast to trauma or myocardial infarction, the signs of stroke are often not recognized as readily by relatives and bystanders or even by medical staff and emergency medical services (EMS), which causes treatment delays. Therefore, by informing the public better and educating emergency personnel concerning stroke, the number of stroke patients treated as an emergency could increase. Prehospital treatment can be targeted towards adequate cerebral oxygenation and individual management of hypertension, treatment of cardiac arrhythmia, and preventing hyperglycemia and hyperthermia. Optimizing the initiation of in-hospital treatment requires early notification of the emergency room personnel in the selected hospital (stroke unit/ stroke team, 24-hour CCT).

Zusammenfassung

In westlichen Industrienationen ist der Schlaganfall die dritthäufigste Todesursache und die häufigste Ursache für erworbene Behinderungen überhaupt. Optimale Behandlungsbedingungen bestehen nur dann, wenn die Frühsymptome des Schlaganfalls rechtzeitig erkannt werden und die Behandlung innerhalb von 3 h nach Einsetzen der Erstsymptome eingeleitet wird. Eine „Rettungskette des Schlaganfalls” muss deshalb Konzepte zur Früherkennung, eine rasche prähospitale Versorgung gefolgt von effizienter Diagnostik und eine unmittelbar einsetzende Akuttherapie sinnvoll integrieren. Der vorliegende Beitrag hat zum Ziel, diesen Ansatz unter besonderer Berürcksichtigung der prähospitalen Phase darzustellen. Diese Akzentuierung erscheint notwendig, da dem Schlaganfall im Vergleich zum Trauma oder Herzinfarkt weitaus weniger Priorität beigenmesse wird. Laien, aber auch rettungsdienstliches und medizinisches Personal erschweren durch diese Auffassung die notfallmäßige Behandlung von Schlaganfallpatienten. Intensivierte Aufklärungs- bzw. Ausbildungsmaßnahmen, die sowohl die Öffentlichkeit als auch notfallmedizinisches Personal berücksichtigen, können eine Verbesserung dieser Situation erreichen. Die Zielgrößen der prähospitalen Behandlung sind eine adäquate zebrale Oxygenierung , ein an den einzelnen Patienten angepasstes Blutdruckniveau, die Behandlung von Herzrhythmusstörungen und das Vermeiden von Hyperglykämie, Hypoglyämie und Hyperthermie. Ein optimaler ßbergang von der prähospitalen in die hospitale Phase der Versorgung ergordert die frühzeitige Anmeldung des Schlaganfallpatienten in der geeigneten Klinik (Stroke-Unit/Stroke-Team, 24-Studen CCT).

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Authors and Affiliations

  1. Klinik für Anästhesiologie Klinikum, Johannes-Gutenberg-Universität, Langenbeckstr.1, 55131, Mainz, Germany

    Dr.med. F. Heid

  2. Kath. St.-Johannes-Gesellschaft gGmbH, Johannesstr. 9-17, Dortmund, 44137, Germany

    Dr.med. H.-J. Hennes

  3. Neurologische Klinik, Rupprecht-Karls-Universität, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany

    PD Dr.med. T. Steiner

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Heid, F., Hennes, HJ., Steiner, T. (2003). Schlaganfallversorgung in der Prähospitalphase. In: Die Notfalltherapie und Intensivtherapie bei Schlaganfall. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57384-2_2

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  • DOI: https://doi.org/10.1007/978-3-642-57384-2_2

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