Notfälle in der Herzgruppe

Kardiale Notfallsituationen Blutdruckentgleisungen – „Hypertensive Krise“ mit oder ohne Lungenödem Herzinfarkt mit Rhythmusstörungen Primäre Herzrhythmustörungen Lungenembolie

Leitsymptome Luftnot, Schwäche Wassereinlagerungen Zyanose Schmerzen (Angina pectoris)

Allgemeine Zeichen Haltung Hautfarbe (Zyanose, Rötung) Hauttemperatur Feuchtigkeit / Schweiß Ödeme (Eindrückbarkeit) (Hals)Venen

Lungenödem

Stauung

Ödeme

Zyanose

Hypertensive Krise

Hypertensive Krise

Hypertensive Krise

Therapie Hypertensive Krise Blutdruck LANGSAM senken Nitro-Spray Kein schnell wirksames Nifedipin (nur retardiertes) Furosemid (Lasix)

Lungenembolie

Lungenembolie

Der Herzinfarkt

Der Herzinfarkt

Herzinfarkt mit Kammerflimmern

Der Herzinfarkt

Der Herzinfarkt: Schmerzausstrahlung

Der Herzinfarkt: Männer & Frauen

Elektrokardiogramm (EKG)

Sinusrhythmus

Ventrikuläre Extrasystolen (VES)

Polytope Ventrikuläre Extrasystolen

Ventrikulärer Bigeminus

Vorhofextrasystolen (SVES)

Störungen durch lockere Elektroden

Tachyarrhythmia absoluta (Vorhofflimmern)

Ventrikuläre Salven

Ventrikuläre Tachykardie

Kammerflattern

Kammerflimmern

Asystolie

AV - Block 3. Grades

Elektromechanische Entkoppelung Puls nicht tastbar !!!!!!!!!!!!!!

Wie gehe ich vor ? 112 anrufen AED / Defi holen; anschließen Brust freimachen, Atemwege freimachen Patient nicht ansprechbar, Pulse nicht tastbar > Herzdruckmassage Pulse tastbar > Blutdruck messen EKG, Sauerstoff, venöser Zugang Differenzierte Therapie durch Notarzt

Pulse

Pulse

Erste Maßnahmen Patient bewußtlos infolge Tachykardie (Femoralis-/Karotispuls nicht tastbar) Sofortige Defibrillation (bis zu 3x) Kardiopulmonale Reanimaton

„Notfallkette“ Früher Notruf - „Phone first“ Frühe Basismaßnahmen (BLS) Frühe Defibrillation Frühe erweiterte Maßnahmen (ALS)

Auf Reaktionen prüfen …

Hilfe rufen …

Kopf strecken, Kinn anheben

Atmung überprüfen …

Herzdruckmassage 100/min 4-5 cm tief

Herzdruckmassage

Reanimation Herzdruckmassage : Beatmung 30 : 2 Zyklen von 5 x 30 : 2 (ca. 2min) Frequenz 100 /min O2 in Höchstdosis Hubvolumen 400 - 600 ml Inspirationszeit 1 - 2 sec

Unbedingt beachten Nach der ersten Defibrillation 2 min CPR (5 Zyklen) Beim Defibrillieren darauf achten, daß niemand Patientenkontakt hat Paddel nur in aufgesetztem Zustand laden Keine Defibrillation auf leitfähigem Untergrund oder nassem Patienten

Wichtiger Grundsatz Asystolie und EMD erfordern neben Beatmung und Herzdruckmassage eine medikamentöse Reanimation VF und VT erfordern schnellstmögliche Defibrillation

So ein Defi ???

... besser diesen

Automatischer Externer Defibrillator (AED) … noch besser diesen Automatischer Externer Defibrillator (AED)

Der plötzliche Herztod ist häufig ! 5 , 1 2 3 S C A S t r o k e L u n g C a c e r The chain of survival concept represents the sequence of four events that must occur quickly to optimize a person's chance of surviving a cardiac arrest. The four links of the chain: • Early Access, the first link, has two components: educating citizens to recognize cardiac arrest and having an emergency dispatch system in place to send trained personnel and equipment to the scene quickly. • Early CPR should be initiated by the person discovering the cardiac arrest. CPR buys time for the patient until arrival of the defibrillator and advanced care. • Early Defibrillation can establish a normal heart rhythm to a person suffering a cardiac arrest. It is most effective when it is performed in the first few minutes of a cardiac arrest. • Early Advanced Cardiac Life Support means that more advanced support such as drugs and intubation can be quickly given if necessary by more advanced care providers such as paramedics, nurses and physicians. B r e a s t C n c A I D S AIDS Brustkrebs Lungenkrebs Schlaganfall PHT

“Die Schlüssel zum Überleben” Schnelle Benachrichtigung Frühe Herzdruckmassage Frühdefibrillation Schnelle unterstützende Behandlung The chain of survival concept represents the sequence of four events that must occur quickly to optimize a person's chance of surviving a cardiac arrest. The four links of the chain: • Early Access, the first link, has two components: educating citizens to recognize cardiac arrest and having an emergency dispatch system in place to send trained personnel and equipment to the scene quickly. • Early CPR should be initiated by the person discovering the cardiac arrest. CPR buys time for the patient until arrival of the defibrillator and advanced care. • Early Defibrillation can establish a normal heart rhythm to a person suffering a cardiac arrest. It is most effective when it is performed in the first few minutes of a cardiac arrest. • Early Advanced Cardiac Life Support means that more advanced support such as drugs and intubation can be quickly given if necessary by more advanced care providers such as paramedics, nurses and physicians.

Warum Frühdefibrillation ? Kammerflimmern ist der häufigste initiale Rhythmus beim akuten Herzstillstand Defibrillation ist die einzige effektive Behandlung Die Wahrscheinlichkeit des Defibrillationserfolgs nimmt mit der Zeit ab Kammerflimmern degeneriert zur Asystolie Defibrillation must be delivered within minutes of a cardiac arrest in order to have the best chance of success. If not done quickly the rhythm will deteriorate into a rhythm which cannot be treated.

Defibrillation must be delivered within minutes of a cardiac arrest in order to have the best chance of success. If not done quickly the rhythm will deteriorate into a rhythm which cannot be treated.

Asystolie: kaum zu behandeln Not all rhythms of cardiac arrest can be treated with electrical shocks. Asystole (“flat line” or no electrical activity of the heart) and pulseless electrical activity (“PEA”—electrical activity but no pumping of the heart) are examples of dysrhythmias that do not respond to external shocks.

Zeit & Wiederbelebungserfolg 10 20 30 40 50 60 70 80 90 100 Erfolg nimmt ab um 7-10% pro Minute % Erfolg Success rates decrease by about 7-10% each minute. The actual relationship between defibrillation success and time is a non-linear one, with the best chance for success probably occurring in the first 3–4 minutes. 1 2 3 4 5 6 7 8 9 Zeit (Minuten)

Zeit bis Defibrillation — Die Uhr tickt ….. Feststellen des Herzstillstandes 1 min. Notruf 1 min. Aktivierung des Einsatzfahrzeugs 1 min. Ankunft Einsatzfahrzeug 6 min. Aufsuchen des Opfers & Schockabgabe 2 min. Verbrauchte Zeit = 11 min. In an emergency situation there are many factors that can determine the response time by EMS. Look at the steps and think how long each would take in your community or workplace. The total time shown on this slide is 11 minutes. In many cases it may even be longer due to problems such as traffic congestion, crowds, security delays, or locating the victim in large public gathering places such as airports, shopping malls and convention centers. As stated earlier, the best chance of survival after a cardiac arrest occurs if defibrillation is achieved in the first 3-4 minutes after collapse.

Vorteile des AED Akustische Kommandos gut verständlich & intuitiv Batterien müssen nicht wieder aufgeladen werden Täglicher Selbsttest, wartungsfrei Advances in technology make AEDs a practical solution to combat the crisis of sudden cardiac arrest in the community. Putting AEDs in the hands of workplace medical emergency response team members, security officers, and other first responders can dramatically reduce the time from collapse to defibrillation and has the potential to greatly improve survival rates.

Vorteile des AED 2 Rhythmus muß nicht selbst beurteilt werden Auch kaum trainiertes Personal kann defibrillieren Reduziert die Zeit bis zur Behandlung Ermöglicht erst die Frühdefibrillation AEDs have eliminated the need to teach rhythm recognition and thus make is easier for those responders with less training to defibrillate. This may reduce the time to therapy. Unfortunately, even with the best efforts, not every person can be saved, but by combining early CPR with early defibrillation, the chance to save a life greatly increases.

Automatischer Externer Defibrillator (AED) EKG – Analyse Stellt durch einen Computeralgorithmus einen schockbaren oder nicht-schockbaren Rhythmus fest Schockt bei Kammerflimmern und Kammertachykardien An automated external defibrillator or AED is a type of defibrillator which analyzes the patient’s rhythm and advises the operator when a shockable rhythm is detected. It is not necessary for the AED operator to be skilled in rhythm recognition. AEDs should only be applied to patients who are unconscious, not breathing, and pulseless with no signs of circulation.

Vorgehen beim AED - Einsatz Vergewissern, daß der Patient nicht atmet und / oder pulslos ist AED einschalten und Elektroden kleben Herzryhthmus wird analysiert Den Stimmanweisungen und Texten auf dem Schirm folgen Defibrillation is easy because screen messages and voice prompts coach the operator through the procedure. The operator must only confirm cardiac arrest, turn on the AED, attach the electrodes, and follow the voice prompts and screen messages.

Elektrodenplazierung Anterior Disposable defibrillation electrodes are placed on the patient's bare chest in the anterior-lateral position. Remove excessive chest hair, sweat, and medication patches before applying the electrodes. Place electrodes by following the diagrams on the electrodes: On the victim’s left ribs—between the nipple and armpit. Press the electrode firmly to the skin. Above the victim’s right nipple, below the collarbone and beside the breast bone (sternum). Do not place over the breast bone. Bone is a poor conductor of electricity. Lateral Anterior-lateral

Elektrodenplazierung Correct electrode placement allows more current to pass through the heart. Avoid placing the electrode over large bones such as the breast bone (sternum) which block the flow of current. Korrekt Innorrekt

Disposable defibrillation electrodes are placed on the patient's bare chest in the anterior-lateral position. Remove excessive chest hair, sweat, and medication patches before applying the electrodes. Place electrodes by following the diagrams on the electrodes: On the victim’s left ribs—between the nipple and armpit. Press the electrode firmly to the skin. Above the victim’s right nipple, below the collarbone and beside the breast bone (sternum). Do not place over the breast bone. Bone is a poor conductor of electricity.

AED mounted on wall in health club, gym or exercise facility

Notfallkoffer

Take Home Message

Vielen Dank für die Aufmerksamkeit !!!