Zusammenfassung
Patienten, die sich in der Notaufnahme mit hämodynamischer Instabilität bzw. einem manifesten Schock präsentieren, stellen differenzialdiagnostisch eine große Herausforderung für den Notfallmediziner dar. Eine rasche Diagnosestellung mit Erkennen der zugrunde liegenden Pathologie, z. B. einem kardialen Low-Output-Versagen, ist für die Therapie und das Überleben des kritisch kranken Patienten entscheidend. Hierbei ist die Echokardiographie am Patientenbett als bildgebendes Verfahren unerlässlich. Nicht eine ausführliche kardiologische, sondern eine schnelle, fokussierte und die wesentliche Pathologie erfassende echokardiographische Untersuchung sollte in der Erstversorgung einer Notaufnahme gewährleistet sein. Eine primäre echokardiographische Unterscheidung in „erhaltene“ vs. „nichterhaltene“ linksventrikuläre Ejektionsfraktion mit anschließend strukturiertem Erfassen bzw. Ausschließen wichtiger Differenzialdiagnosen ist diagnostisch zielführend.
Abstract
Detection of acute cardiac dysfunction and differential diagnosis of low cardiac output syndrome is challenging for emergency physicians. For the critical ill patient it is essential to rapidly identify the underlying disease to initiate the correct therapy and optimize patient outcome. Echocardiography is the diagnostic tool of choice for the evaluation of low cardiac output states. In the setting of the emergency department the use of focused echocardiography instead of detailed echocardiographic studies of cardiologists is appropriate and should be provided for emergency care. The differentiation in preserved versus reduced left ventricular ejection fraction as a first assessment is helpful, particularly for physicians not well trained in echocardiography. The structured and focused approach to evaluate or exclude differential diagnoses of cardiac dysfunction is the key for optimal management of acute and critically ill patients with low cardiac output.
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Dieser Beitrag erschien ursprünglich in der Zeitschrift Notfall + Rettungsmedizin 4/2012. Die Teilnahme an der Fortbildung ist nur einmal möglich.
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Schmidt, J., Maier, A. & Christ, M. Echokardiographie in der Notaufnahme. Med Klin Intensivmed Notfmed 107, 571–583 (2012). https://doi.org/10.1007/s00063-012-0167-1
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DOI: https://doi.org/10.1007/s00063-012-0167-1
Schlüsselwörter
- Low-Output-Versagen
- Kardiogener Schock
- Echokardiographie in der Notaufnahme
- Linksventrikuläre Funktion
- Rechtsventrikuläre Funktion