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Diagnostik in der Notfallmedizin: Warum die Anamnese entscheidend ist

Diagnostic investigation in emergency medicine: Why case history is crucial

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Zusammenfassung

Berichtet wird ein präklinischer Fall mit stärkstem Thoraxschmerz. Die initiale Diagnostik ist erschwert und ohne klaren Befund. Erst die detaillierte Anamnese nach suffizienter Schmerztherapie ergibt den Zusammenhang zwischen Beschwerden und Erbrechen und lenkt den Verdacht auf eine Hohlorganverletzung. Es kann als primäres Ziel eine chirurgische Notaufnahme angefahren und der Befund eines Boerhaave-Syndroms bestätigt werden. Der Patient wurde nach sekundärer Verschlechterung, kardiopulmonaler Reanimation (CPR) und operativer Versorgung sieben Stunden nach Erstkontakt auf die Intensivstation (ITS) übernommen.

Abstract

We present the preclinical case of a patient reporting chest pain. Pain impeded physical examination. Reviewing the patient’s detailed medical history after analgesia revealed a connection between the reported pain and vomiting. This led to a suspicion of organ perforation. Thus, the patient was admitted to a surgical emergency room (ER) and Boerhaave’s Syndrome was diagnosed. After deterioration in the ER, cardiopulmonal reanimation (CPR), and successful surgical treatment, the patient was transferred to the intensive care unit (ICU) seven hours after first contact.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland

    M. Mirus & A. R. Heller

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  1. M. Mirus
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Correspondence to M. Mirus.

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Interessenkonflikt

M. Mirus und A. R. Heller geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Mirus, M., Heller, A.R. Diagnostik in der Notfallmedizin: Warum die Anamnese entscheidend ist. Anaesthesist 66, 256–264 (2017). https://doi.org/10.1007/s00101-017-0280-x

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