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Unklare Bauchschmerzen in der zentralen Notaufnahme

Ein Algorithmus

Unclear abdominal pain in central emergency admissions

An algorithm

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Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Bauchschmerzen sind ein häufiges Leitsymptom in der Notaufnahme mit einem breiten differenzialdiagnostischen Spektrum. Es gilt, akut lebensbedrohliche Ursachen innerhalb kürzester Zeit zu identifizieren und der entsprechenden medikamentös-konservativen oder interventionellen Therapie zuzuführen. Der vorgestellte diagnostische Algorithmus beginnt bereits bei Erstkontakt in der Notaufnahme mit der Triage. Vor dem Diagnosestandard steht der interdisziplinäre Dialog mit dem daraus resultierenden diagnostischen Auftrag mit vertiefter Anamnese und Untersuchung des Patienten. Der Behandlungsstandard wird durch den jeweiligen Stellenwert der diagnostischen Möglichkeiten bestimmt. Eine weiterführende Bildgebung oder Interventionen können erst nach der fachärztlichen Würdigung der Befunde eingeleitet werden. Trotz differenzierter Diagnostik bleiben etwa 30% der Bauchschmerzen ätiologisch unklar. In diesen Fällen kann eine Verlaufsbeobachtung auf einer der Notaufnahme angegliederten bettenführenden Station sinnvoll sein, um eine sichere Diagnosestellung zu ermöglich, die dann auch eine gezielte Weiterbehandlung ambulant, stationär oder im Operationssaal ermöglicht.

Abstract

One of the chief complaints in the emergency department is abdominal pain which is associated with a large spectrum of possible underlying diagnoses. Life-threatening diseases have to be identified urgently to treat them rapidly either conservatively or by surgical intervention. The algorithm presented in this article starts with the triage in the emergency department. After triage the first step in the algorithm is an interdisciplinary communication to start the standardized diagnostic process which includes medical history, clinical examination, laboratory analyses, ultrasound and electrocardiogram. Further diagnostic escalation should be done in unspecific and urgent cases of abdominal pain after consulting a specialist. In approximately 30 % of patients with abdominal pain on admittance to an emergency department the cause remains unclear after undergoing the diagnostic process. In these cases it can be useful for risk stratification to transfer the patient to a ward related to the emergency department for observation und further diagnostics.

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Berner, L., Dormann, H. Unklare Bauchschmerzen in der zentralen Notaufnahme. Med Klin Intensivmed Notfmed 108, 33–40 (2013). https://doi.org/10.1007/s00063-012-0172-4

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  • DOI: https://doi.org/10.1007/s00063-012-0172-4

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