{"id":6427,"date":"2018-01-28T04:59:20","date_gmt":"2018-01-28T03:59:20","guid":{"rendered":"http:\/\/news-papers.eu\/?p=6427"},"modified":"2017-11-26T20:03:53","modified_gmt":"2017-11-26T19:03:53","slug":"neuen-esc-guidelines-fuer-den-stemi","status":"publish","type":"post","link":"http:\/\/news-papers.eu\/?p=6427","title":{"rendered":"Neue ESC-Guideline f\u00fcr den STEMI"},"content":{"rendered":"<p><strong><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"4369\" data-permalink=\"http:\/\/news-papers.eu\/?attachment_id=4369\" data-orig-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/04\/EKG_Herz.jpg?fit=1280%2C720\" data-orig-size=\"1280,720\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"EKG Herz\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/04\/EKG_Herz.jpg?fit=1024%2C576\" class=\"size-medium wp-image-4369 alignright\" src=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/04\/EKG_Herz.jpg?resize=300%2C169\" alt=\"\" width=\"300\" height=\"169\" srcset=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/04\/EKG_Herz.jpg?resize=300%2C169 300w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/04\/EKG_Herz.jpg?resize=768%2C432 768w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/04\/EKG_Herz.jpg?resize=1024%2C576 1024w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/04\/EKG_Herz.jpg?resize=750%2C422 750w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/04\/EKG_Herz.jpg?w=1280 1280w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/>Ein Beitrag von PD Dr. J\u00fcrgen Knapp, Bern\/Schweiz:<\/strong><\/p>\n<p><strong>Was bieten die neuen ESC-Guidelines Neues f\u00fcr die pr\u00e4hospitale Versorgung von STEMI-Patienten?<\/strong><\/p>\n<p>\u201eKilling your darlings\u201c\u2026von der fr\u00fcher \u00fcblichen Therapie Nitro-Spray, Sauerstoff, ASS und Morpin ist nicht mehr viel \u00fcbrig.<\/p>\n<blockquote><p><strong>The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC): 2017 ESC Guidelines for themanagement of acutemyocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2017<\/strong><\/p><\/blockquote>\n<hr \/>\n<ul>\n<li><strong>keine routinem\u00e4\u00dfige Gabe von Sauerstoff<\/strong>, nur bei einer <strong>SaO2 von &lt;90% <\/strong>indiziert (<a href=\"http:\/\/www.ahjonline.com\/article\/S0002-8703(11)00827-1\/pdf\" target=\"_blank\" rel=\"noopener\"><strong>AVOID<\/strong><\/a> und <a href=\"http:\/\/news-papers.eu\/deto2x-ami-studie-schadet-sauerstoff-bei-myokardinfarkt\" target=\"_blank\" rel=\"noopener\"><strong>DETO2X<\/strong><\/a> Trials).<\/li>\n<li><strong>keine routinem\u00e4\u00dfige Schmerztherapie mit Morphin <\/strong><\/li>\n<\/ul>\n<p><em>Begr\u00fcndung: Morphin f\u00fchrt zu einer verz\u00f6gerten Aufnahme der oral verabreichten P<sub>2<\/sub>Y<sub>12<\/sub>-Inhibitoren. <\/em><\/p>\n<ul>\n<li>Bei Patienten, bei denen weniger der Thoraxschmerz im Vordergrund steht, sondern die Aufregung und Angst und eine damit verbundene Sympathikusaktivierung und Vasokonstriktion, sollten <strong>Benzodiazepine<\/strong> verabreicht werden.<\/li>\n<li>auch <strong>keine<\/strong> <strong>routinem\u00e4\u00dfige Einsatz von Nitroglyzerin bei STEMI-Patienten <\/strong>(kein Nutzen hinsichtlich Mortalit\u00e4t in der ISIS-4 Studie)<\/li>\n<li>m\u00f6glichst fr\u00fchzeitige Gabe eines<strong> \u03b2-Blockers <\/strong>bei h\u00e4modynamisch stabilen STEMI Patienten (Klasse IIa). CAVE: Vorsichtig und langsam dosieren. Bei beginnendem kardiogenen Schock, der klinisch noch nicht erkennbar ist, fatale Folgen m\u00f6glich.<\/li>\n<li>75-250 mg <strong>ASS <\/strong>i.v., oft sieht man immer noch die \u201ealten 500 mg\u201c<\/li>\n<li>F\u00fcr die pr\u00e4hospitale Gabe von P2Y12-Hemmern gibt es nach wie vor keine Evidenz. Dennoch empfehlen die <strong>Guidelines die m\u00f6glichst fr\u00fche Gabe von Ticagrelor (Brilique\u00ae) 180mg oder Prasugrel 60mg (<\/strong>Klasse I Empfehlung).<\/li>\n<\/ul>\n<p><em>Anmerkung: Clopidogrel (Plavix\u00ae) nur bei elektiver Koronarangiografie oder bei Notfallpatienten mit vorbestehender oraler Antikoagulation (z.B. Marcumar oder NOAK).<\/em><\/p>\n<ul>\n<li><strong>Heparine<\/strong>: Heparin, 70-100 IU\/kg (Klasse I) oder Enoxaparin 0.5mg\/kg (Klasse IIa), bei Patienten mit HIT Bivalirudin.<\/li>\n<li><strong>Statine<\/strong>: Atorvastatin 80 mg als loading dosis m\u00f6glichst fr\u00fchzeitg, aber pr\u00e4hospital bisher nicht untersucht<\/li>\n<\/ul>\n<hr \/>\n<p><strong>Links:<\/strong><\/p>\n<ul>\n<li><a href=\"http:\/\/www.lifeinthefastlane.com\"><strong>lifeinthefastlane.com<\/strong><\/a><\/li>\n<li><a href=\"http:\/\/hqmeded-ecg.blogspot.de\"><strong> Smiths EKG-blog<\/strong><\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Ein Beitrag von PD Dr. J\u00fcrgen Knapp, Bern\/Schweiz: Was bieten die neuen ESC-Guidelines Neues f\u00fcr die pr\u00e4hospitale Versorgung von STEMI-Patienten? \u201eKilling your darlings\u201c\u2026von der fr\u00fcher \u00fcblichen Therapie Nitro-Spray, Sauerstoff, ASS [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":4369,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"__cvm_playback_settings":[],"__cvm_video_id":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false},"categories":[1079],"tags":[225,1267,465],"class_list":["post-6427","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-kardiovaskulaerer-notfall","tag-herzinfarkt","tag-praehospitale-therapie","tag-stemi"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/04\/EKG_Herz.jpg?fit=1280%2C720","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7fR2g-1FF","jetpack-related-posts":[{"id":5526,"url":"http:\/\/news-papers.eu\/?p=5526","url_meta":{"origin":6427,"position":0},"title":"ESC 2017 Guideline zum STEMI","author":"Michael Bernhard","date":"Oktober 18, 2017","format":false,"excerpt":"Am 26.08.2017 sind die neuen European Society of Cardiology (ESC) Guidelines zum Versorgung des ST-Hebungsinfarktes erschienen: The Task Force for the management of acute myocardial infarction\u00a0in patients presenting with ST-segment elevation of the European\u00a0Society of Cardiology (ESC). \u00a02017 ESC Guidelines for the management of\u00a0acute myocardial infarction in patients\u00a0presenting with ST-segment\u2026","rel":"","context":"In &quot;Kardiovaskul\u00e4rer Notfall&quot;","block_context":{"text":"Kardiovaskul\u00e4rer Notfall","link":"http:\/\/news-papers.eu\/?cat=1079"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/10\/Herz-300x201.png?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":6977,"url":"http:\/\/news-papers.eu\/?p=6977","url_meta":{"origin":6427,"position":1},"title":"ACCELERATOR-2","author":"Michael Bernhard","date":"Februar 7, 2018","format":false,"excerpt":"Ein Beitrag von PD Dr\b. 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DOI: 10.1161\/CIRCULATIONAHA.116.021886 Die Kollegen greifen dabei die erschienen publizierten\u2026","rel":"","context":"In &quot;Herz-Kreislauf&quot;","block_context":{"text":"Herz-Kreislauf","link":"http:\/\/news-papers.eu\/?cat=8"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":2112,"url":"http:\/\/news-papers.eu\/?p=2112","url_meta":{"origin":6427,"position":3},"title":"Aktuelle \u00dcbersichtsarbeit: Akuter Myokardinfarkt","author":"Michael Bernhard","date":"September 20, 2016","format":false,"excerpt":"In The Lancet ist eine aktuelle \u00dcbersichtsarbeit zum akuten Myokardinfarkt publiziert worden: Reed GW, et al. Acute myocardial infarction. 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