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Erschienen in: Notfall +  Rettungsmedizin 5/2017

07.07.2017 | CME

Dyspnoe in präklinischer und klinischer Notfallmedizin

verfasst von: Dr. B. Schmid, K. Fink, J. Kron, H.-J. Busch

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 5/2017

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Zusammenfassung

Dyspnoe (Atemnot) ist ein häufiger und potenziell lebensbedrohlicher Symptomenkomplex in der präklinischen und der klinischen Notfallmedizin, der eine schnelle und effektive Behandlung erfordert. Hierunter kann sich ein weites Spektrum an Erkrankungen verbergen, das die Behandelnden vor viele Herausforderungen stellt. Um den Patienten einer zielorientierten Diagnostik und einer adäquaten Initialtherapie zuführen zu können, sind die Kenntnis der verschiedenen Differenzialdiagnosen sowie eine rasche Risikostratifizierung und Priorisierung der einzuleitenden Maßnahmen unabdingbar. Der vorliegende Beitrag zeigt die wichtigsten Differenzialdiagnosen der akuten Atemnot auf und bietet einen Handlungsleitfaden für das initiale Vorgehen bei Atemnot.
Literatur
1.
Zurück zum Zitat Parshall MB et al (2012) An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 185(4):435–452 CrossRefPubMedPubMedCentral Parshall MB et al (2012) An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 185(4):435–452 CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Mockel M et al (2013) Chief complaints in medical emergencies: do they relate to underlying disease and outcome? The Charité Emergency Medicine Study (CHARITEM). Eur J Emerg Med 20:103–108 CrossRefPubMed Mockel M et al (2013) Chief complaints in medical emergencies: do they relate to underlying disease and outcome? The Charité Emergency Medicine Study (CHARITEM). Eur J Emerg Med 20:103–108 CrossRefPubMed
4.
5.
Zurück zum Zitat Barfod C et al (2012) Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department – a prospective cohort study. Scand J Trauma Resusc Emerg Med 20:28 CrossRefPubMedPubMedCentral Barfod C et al (2012) Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department – a prospective cohort study. Scand J Trauma Resusc Emerg Med 20:28 CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Barker SJ, Tremper KK (1987) The effect of carbon monoxide inhalation on pulse oximetry and transcutaneous PO2. Anesthesiology 66:677–679 CrossRefPubMed Barker SJ, Tremper KK (1987) The effect of carbon monoxide inhalation on pulse oximetry and transcutaneous PO2. Anesthesiology 66:677–679 CrossRefPubMed
7.
Zurück zum Zitat Kaiser G, Schaper A (2012) Akute Kohlenmonoxidvergiftung – Ein alter Hut in neuen Schachteln. Notf Rettungsmed 15:429–435 CrossRef Kaiser G, Schaper A (2012) Akute Kohlenmonoxidvergiftung – Ein alter Hut in neuen Schachteln. Notf Rettungsmed 15:429–435 CrossRef
8.
Zurück zum Zitat Eisenberg MJ, de Romeral LM, Heidenreich PA, Schiller NB, Evans GT (1996) The diagnosis of pericardial effusion and cardiac tamponade by 12-lead ECG. A technology assessment. Chest 110:318–324 CrossRefPubMed Eisenberg MJ, de Romeral LM, Heidenreich PA, Schiller NB, Evans GT (1996) The diagnosis of pericardial effusion and cardiac tamponade by 12-lead ECG. A technology assessment. Chest 110:318–324 CrossRefPubMed
9.
Zurück zum Zitat Beglinger B et al (2015) Physician’s first clinical impression of emergency department patients with nonspecific complaints is associated with morbidity and mortality. Medicine (Baltimore) 94:e374 CrossRef Beglinger B et al (2015) Physician’s first clinical impression of emergency department patients with nonspecific complaints is associated with morbidity and mortality. Medicine (Baltimore) 94:e374 CrossRef
10.
Zurück zum Zitat Katus HA et al (1991) Diagnostic efficiency of troponin T measurements in acute myocardial infarction. Circulation 83:902–912 CrossRefPubMed Katus HA et al (1991) Diagnostic efficiency of troponin T measurements in acute myocardial infarction. Circulation 83:902–912 CrossRefPubMed
11.
Zurück zum Zitat Keller T et al (2009) Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 361:868–877 CrossRefPubMed Keller T et al (2009) Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 361:868–877 CrossRefPubMed
12.
Zurück zum Zitat Thygesen K, Alpert JS, White HD (2007) Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. Eur Heart J 28:2525–2538 CrossRefPubMed Thygesen K, Alpert JS, White HD (2007) Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. Eur Heart J 28:2525–2538 CrossRefPubMed
13.
Zurück zum Zitat deFilippi CR, Herzog CA (2017) Interpreting cardiac biomarkers in the setting of chronic kidney disease. Clin Chem 63:59–65 CrossRefPubMed deFilippi CR, Herzog CA (2017) Interpreting cardiac biomarkers in the setting of chronic kidney disease. Clin Chem 63:59–65 CrossRefPubMed
14.
Zurück zum Zitat Nielsen LS, Svanegaard J, Klitgaard NA, Egeblad H (2004) N‑terminal pro-brain natriuretic peptide for discriminating between cardiac and non-cardiac dyspnoea. Eur J Heart Fail 6:63–70 CrossRefPubMed Nielsen LS, Svanegaard J, Klitgaard NA, Egeblad H (2004) N‑terminal pro-brain natriuretic peptide for discriminating between cardiac and non-cardiac dyspnoea. Eur J Heart Fail 6:63–70 CrossRefPubMed
15.
Zurück zum Zitat Authors/Task Force Members et al (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33:1787–1847 CrossRef Authors/Task Force Members et al (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33:1787–1847 CrossRef
16.
Zurück zum Zitat Kragelund C, Grønning B, Køber L, Hildebrandt P, Steffensen R (2005) N‑terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med 352:666–675 CrossRefPubMed Kragelund C, Grønning B, Køber L, Hildebrandt P, Steffensen R (2005) N‑terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med 352:666–675 CrossRefPubMed
17.
Zurück zum Zitat Deonarine P, de Wet C, McGhee A (2012) Computed tomographic pulmonary angiography and pulmonary embolism: predictive value of a d-dimer assay. BMC Res Notes 5:104 CrossRefPubMedPubMedCentral Deonarine P, de Wet C, McGhee A (2012) Computed tomographic pulmonary angiography and pulmonary embolism: predictive value of a d-dimer assay. BMC Res Notes 5:104 CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Douma RA et al (2010) Potential of an age adjusted D‑dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts. BMJ 340:c1475–c1475 CrossRefPubMedPubMedCentral Douma RA et al (2010) Potential of an age adjusted D‑dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts. BMJ 340:c1475–c1475 CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Konstantinides SV (2014) 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35:3145–3146 CrossRefPubMed Konstantinides SV (2014) 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35:3145–3146 CrossRefPubMed
21.
Zurück zum Zitat Michels G, Breitkreutz R, Pfister R (2014) Value of lung ultrasound in emergency and intensive care medicine. Dtsch Med Wochenschr 139:2301–2307 CrossRefPubMed Michels G, Breitkreutz R, Pfister R (2014) Value of lung ultrasound in emergency and intensive care medicine. Dtsch Med Wochenschr 139:2301–2307 CrossRefPubMed
22.
23.
Zurück zum Zitat Ewig S et al (2016) Management of adult community-acquired pneumonia and prevention – update 2016. Pneumologie 70:151–200 CrossRefPubMed Ewig S et al (2016) Management of adult community-acquired pneumonia and prevention – update 2016. Pneumologie 70:151–200 CrossRefPubMed
24.
Zurück zum Zitat Behrakis PK, Baydur A, Jaeger MJ, Milic-Emili J (1983) Lung mechanics in sitting and horizontal body positions. Chest 83:643–646 CrossRefPubMed Behrakis PK, Baydur A, Jaeger MJ, Milic-Emili J (1983) Lung mechanics in sitting and horizontal body positions. Chest 83:643–646 CrossRefPubMed
25.
Zurück zum Zitat Hafner S, Beloncle F, Koch A, Radermacher P, Asfar P (2015) Hyperoxia in intensive care, emergency, and peri-operative medicine: Dr. Jekyll or Mr. Hyde? A 2015 update. Ann Intensive Care 5:42 CrossRefPubMedPubMedCentral Hafner S, Beloncle F, Koch A, Radermacher P, Asfar P (2015) Hyperoxia in intensive care, emergency, and peri-operative medicine: Dr. Jekyll or Mr. Hyde? A 2015 update. Ann Intensive Care 5:42 CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R (2010) Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ 341:c5462–c5462 CrossRefPubMedPubMedCentral Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R (2010) Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ 341:c5462–c5462 CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Allison MG, Winters ME (2016) Noninvasive ventilation for the emergency physician. Emerg Med Clin North Am 34:51–62 CrossRefPubMed Allison MG, Winters ME (2016) Noninvasive ventilation for the emergency physician. Emerg Med Clin North Am 34:51–62 CrossRefPubMed
28.
Zurück zum Zitat Schönhofer B et al (2008) Clinical practice guideline: non-invasive mechanical ventilation as treatment of acute respiratory failure. Dtsch Arztebl Int 105:424–433 PubMedPubMedCentral Schönhofer B et al (2008) Clinical practice guideline: non-invasive mechanical ventilation as treatment of acute respiratory failure. Dtsch Arztebl Int 105:424–433 PubMedPubMedCentral
29.
Zurück zum Zitat Abholz HH (2012) Nationale Versorgungsleitlinie COPD, 2012, Version 1.9 Abholz HH (2012) Nationale Versorgungsleitlinie COPD, 2012, Version 1.9
30.
Zurück zum Zitat Vogelmeier C et al (2007) Guidelines for the diagnosis and therapy of COPD issued by Deutsche Atemwegsliga and Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin. Pneumologie 61:e1–e40 CrossRefPubMed Vogelmeier C et al (2007) Guidelines for the diagnosis and therapy of COPD issued by Deutsche Atemwegsliga and Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin. Pneumologie 61:e1–e40 CrossRefPubMed
31.
Zurück zum Zitat Ring J et al (2014) Guideline for acute therapy and management of anaphylaxis: S2 Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Association of German Allergologists (AeDA), the Society of Pediatric Allergy and Environmental Medicine (GPA), the German Academy of Allergology and Environmental Medicine (DAAU), the German Professional Association of Pediatricians (BVKJ), the Austrian Society for Allergology and Immunology (ÖGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), the German Society of Pharmacology (DGP), the German Society for Psychosomatic Medicine (DGPM), the German Working Group of Anaphylaxis Training and Education (AGATE) and the patient organization German Allergy and Asthma Association (DAAB). Allergo J Int 23:96–112 CrossRefPubMedPubMedCentral Ring J et al (2014) Guideline for acute therapy and management of anaphylaxis: S2 Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Association of German Allergologists (AeDA), the Society of Pediatric Allergy and Environmental Medicine (GPA), the German Academy of Allergology and Environmental Medicine (DAAU), the German Professional Association of Pediatricians (BVKJ), the Austrian Society for Allergology and Immunology (ÖGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), the German Society of Pharmacology (DGP), the German Society for Psychosomatic Medicine (DGPM), the German Working Group of Anaphylaxis Training and Education (AGATE) and the patient organization German Allergy and Asthma Association (DAAB). Allergo J Int 23:96–112 CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Leuppi JD et al (2013) Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA 309:2223–2231 CrossRefPubMed Leuppi JD et al (2013) Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA 309:2223–2231 CrossRefPubMed
33.
Zurück zum Zitat Nationale Versorgungsleitlinie – Asthma der Bundesärztekammer, der kassenärztlichen Bundesvereinigung und der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (2009). Nationale Versorgungsleitlinie – Asthma der Bundesärztekammer, der kassenärztlichen Bundesvereinigung und der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (2009).
34.
Zurück zum Zitat Choo KJL, Simons E, Sheikh A (2010) Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review. Allergy 65:1205–1211 CrossRefPubMed Choo KJL, Simons E, Sheikh A (2010) Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review. Allergy 65:1205–1211 CrossRefPubMed
35.
Zurück zum Zitat Roffi M et al (2016) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 37:267–315 CrossRefPubMed Roffi M et al (2016) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 37:267–315 CrossRefPubMed
36.
Zurück zum Zitat Ewig S, Höffken G, Kern WV et al (2016) S3-Leitlinie: Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention – Update 2016 ( www.​awmf.​org) Ewig S, Höffken G, Kern WV et al (2016) S3-Leitlinie: Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention – Update 2016 ( www.​awmf.​org)
37.
Zurück zum Zitat Dalhoff K, Abele-Horn M, Andreas S et al (2012) S3-Leitlinie: Epidemiologie, Diagnostik und Therapie erwachsener Patienten mit nosokomialer Pneumonie. www.​awmf.​org. Dalhoff K, Abele-Horn M, Andreas S et al (2012) S3-Leitlinie: Epidemiologie, Diagnostik und Therapie erwachsener Patienten mit nosokomialer Pneumonie. www.​awmf.​org.
38.
Zurück zum Zitat Light RW et al (1989) Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 139:126–133 CrossRefPubMed Light RW et al (1989) Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 139:126–133 CrossRefPubMed
39.
Zurück zum Zitat Ekström MP, Bornefalk-Hermansson A, Abernethy AP, Currow DC (2014) Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study. BMJ 348:g445–g445 CrossRefPubMedPubMedCentral Ekström MP, Bornefalk-Hermansson A, Abernethy AP, Currow DC (2014) Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study. BMJ 348:g445–g445 CrossRefPubMedPubMedCentral
Metadaten
Titel
Dyspnoe in präklinischer und klinischer Notfallmedizin
verfasst von
Dr. B. Schmid
K. Fink
J. Kron
H.-J. Busch
Publikationsdatum
07.07.2017
Verlag
Springer Medizin
Erschienen in
Notfall + Rettungsmedizin / Ausgabe 5/2017
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI
https://doi.org/10.1007/s10049-017-0327-1