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Notfallmedizin up2date 2017; 12(02): 159-170
DOI: 10.1055/s-0042-123110
Internistische Notfälle
Georg Thieme Verlag KG Stuttgart · New York

Herzinfarkt in der Notfallmedizin – Update zu Management und Therapie

Sebastian Keil
,
Holger Thiele
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Publikationsverlauf

Publikationsdatum:
02. Juni 2017 (online)

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Das akute Koronarsyndrom (ACS) stellt unverändert eine der häufigsten Diagnosen dar, mit denen das Rettungsdienstpersonal konfrontiert wird. Das Management des ACS beginnt mit dem ersten medizinischen Kontakt durch den Notarzt bzw. das Rettungsdienstpersonal. Für alle Entitäten des Herzinfarktes ist die invasive Diagnostik mit Revaskularisation mittels perkutaner Koronarintervention (PCI) entscheidend für die Prognose.
Kernaussagen

  • Das akute Koronarsyndrom setzt sich zusammen aus den Entitäten

    • ST-Strecken-Hebungsinfarkt (STEMI),

    • Nicht-ST-Strecken-Hebungsinfarkt (NSTEMI) und

    • instabile Angina pectoris (AP).

  • NSTEMI und instabile Angina pectoris unterscheidet sich durch die Erhöhung von Troponin.

  • Für die Therapie ist für alle Entitäten die invasive Diagnostik mit Revaskularisation mittels perkutaner Koronarintervention (PCI) entscheidend, wobei beim STEMI wichtige Zeitvorgaben einzuhalten sind.

  • Prähospitale Medikamentengabe:

    • Für die prähospitale Therapie ist die Gabe von unfraktioniertem Heparin (UFH) und Azetylsalizylsäure (ASS) die Standardmedikation.

    • Die Sauerstoffgabe sollte nur bei reduzierter Sauerstoffsättigung < 95% gegeben werden.

    • Morphingabe nur bei starken Schmerzen.

    • Die Gabe von weiteren Plättcheninhibitoren prähospital hat nach jetzigen Daten keinen Zusatznutzen.

  • Für die Auswahl der Zielklinik sollten folgende Faktoren für den Notarzt von Bedeutung sein:

    • eine 24-Stunden-Bereitschaft zur perkutanen Koronarintervention (PCI),

    • optimierte interne Organisation mit kurzen Door-to-Balloon-Zeiten und

    • das Katheterisieren via A. radialis.

Schlüsselwörter

akutes Koronarsyndrom - Herzinfarkt - Myokardinfarkt - prähospitale Therapie - Door-to-Balloon-Zeit
 

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