Plötzliche Bewusstlosigkeit – Synkope im Notarztdienst

Zusammenfassung

Bewusstlosigkeit ist im Notarztdienst häufiger Anlass zur Alarmierung. Der Notarzt muss Synkopen von anderen Krankheitsbildern, die mit Bewusstlosigkeit einhergehen können, abgrenzen. Die Synkopen selbst können vielerlei – teilweise harmlose, teilweise aber auch schwerwiegende – Ursachen haben. Daher ist ein strukturiertes Vorgehen bei der Einsatzabwicklung notwendig, um Hochrisikopatienten nicht zu übersehen. Hier führt eine zielgerichtete Anamnese, ergänzt durch eine sorgfältige körperliche Untersuchung und ein Basismonitoring inklusive 12-Kanal-EKG zum Ziel.

Abstract

Emergency services are often called to unconscious patients. The emergency physician has to differentiate real syncope from other possible reasons for loss of consciousness. There are many causes for syncopes – benign as well as severe ones. For not to miss patients at high risk, a structured workup is necessary. A distinct medical history is gainful, which is completed with a basic monitoring including a 12 lead ECG.

Schlüsselwörter:

Synkope - Risikostratifizierung - Kollaps - Herzrhythmusstörung - Krampfanfall

Keywords:

syncope - risk stratifikation - collapse - dysrhythmia - seizure

• Literatur

• 1 American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of patients presenting with syncope. Ann Emerg Med 2001; 37: 771-776
• 2 Alboni P, Brignole M, Menozzi C et al Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol 2001; 37: 1921-1928
• 3 Bergfeldt L. Differential diagnosis of cardiogenic syncope and seizure disorders. Heart 2003; 89: 353-358
• 4 Blanc JJ, L‘Her C, Touiza A et al Prospective evaluation and outcome of patients admitted for syncope over a 1 year period. Eur Heart J 2002; 23: 815-820
• 5 Brignole M. Diagnosis and treatment of syncope. Heart 2007; 93: 130-136
• 6 Brigo F, Nardone R, Ausserer H et al The diagnostic value of urinary incontinence in the differential diagnosis of seizures. Seizure 22: 85–90
• 7 Colivicchi F, Ammirati F, Melina D et al Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur Heart J 2003; 24: 811-819
• 8 Grossman SA, Babineau M, Burke L et al Do outcomes of near syncope parallel syncope?. Am J Emerg Med 2012; 30: 203-206
• 9 Grossman SA, Fischer C, Kancharla A et al Can benign etiologies predict benign outcomes in high-risk syncope patients?. J Emerg Med 2011; 40: 592-597
• 10 Harth A, Winther B, Kulla M. Epileptic seizure – a guidline for prehospital diagnosis and treatment. Notarzt 2016; 32: 40-45
• 11 Hayes OW. Evaluation of syncope in the emergency department. Emerg Med Clin North Am 1998; 16: 601–615 viii
• 12 Kapoor WN. Evaluation and management of the patient with syncope. JAMA 1992; 268: 2553-2560
• 13 Martin TP, Hanusa BH, Kapoor WN. Risk stratification of patients with syncope. Ann Emerg Med 1997; 29: 459-466
• 14 Middlekauff HR, Stevenson WG, Stevenson LW et al Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope. J Am Coll Cardiol 1993; 21: 110-116
• 15 Moya A, Sutton R, Ammirati F et al Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; 30: 2631-2671
• 16 Quinn JV, Stiell IG, McDermott DA et al Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes. Ann Emerg Med 2004; 43: 224–232
• 17 Reed MJ, Newby DE, Coull AJ et al The Risk stratification Of Syncope in the Emergency department (ROSE) pilot study: a comparison of existing syncope guidelines. Emerg Med J 2007; 24: 270-275
• 18 Rehm CG, Ross SE. Syncope as etiology of road crashes involving elderly drivers. Am Surg 1995; 61: 1006-1008
• 19 Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med 2002; 18: 141-158
• 20 Sarasin FP, Louis-Simonet M, Carballo D et al Prevalence of orthostatic hypotension among patients presenting with syncope in the ED. Am J Emerg Med 2002; 20: 497-501
• 21 Savage DD, Corwin L, McGee DL et al Epidemiologic features of isolated syncope: the Framingham Study. Stroke 1985; 16: 626-629
• 22 Sayk F, Berndt MJ. Synkope – Algorithmen in der Notfallmedizin. Med Klin Intensivmed Notfmed 2012; 108: 25-32
• 23 Soteriades ES, Evans JC, Larson MG et al Incidence and prognosis of syncope. N Engl J Med 2002; 347: 878-885
• 24 Strickberger SA, Benson DW, Biaggioni I et al AHA/ACCF Scientific Statement on the evaluation of syncope: from the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: in collaboration with the Heart Rhythm Society: endorsed by the American Autonomic Society. Circulation 2006; 113: 316-327
• 25 Sun BC, Emond JA, Camargo Jr CA. Characteristics and admission patterns of patients presenting with syncope to U.S. emergency departments, 1992-2000. Acad Emerg Med 2004; 11: 1029–1034
• 26 Sun BC, Hoffman JR, Mower WR et al Low diagnostic yield of electrocardiogram testing in younger patients with syncope. Ann Emerg Med 2008; 51: 240–246 246 e241
• 27 Thiruganasambandamoorthy V, Stiell IG, Wells GA et al Outcomes in presyncope patients: a prospective cohort study. Ann Emerg Med 2015; 65: 268–276 e266
• 28 Xu Y, Nguyen D, Mohamed A et al Frequency of a false positive diagnosis of epilepsy: A systematic review of observational studies. Seizure 2016; 41: 167-174