{"id":6635,"date":"2018-01-15T04:40:21","date_gmt":"2018-01-15T03:40:21","guid":{"rendered":"http:\/\/news-papers.eu\/?p=6635"},"modified":"2017-12-27T12:13:02","modified_gmt":"2017-12-27T11:13:02","slug":"6635-2","status":"publish","type":"post","link":"https:\/\/news-papers.eu\/?p=6635","title":{"rendered":"Hypertensiver Notfall &#8211; Teil 3"},"content":{"rendered":"<p style=\"text-align: justify;\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"6403\" data-permalink=\"https:\/\/news-papers.eu\/?attachment_id=6403\" data-orig-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/11\/Blutdruck-e1511700462767.jpg?fit=300%2C200&amp;ssl=1\" data-orig-size=\"300,200\" 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=\"Blutdruck\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/11\/Blutdruck-e1511700462767.jpg?fit=1024%2C683&amp;ssl=1\" class=\"size-medium wp-image-6403 alignright\" src=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/11\/Blutdruck.jpg?resize=300%2C200\" alt=\"\" width=\"300\" height=\"200\" \/>Nun zu <strong>Teil 3<\/strong>\u00a0der Serie zum\u00a0<strong>hypertensiven Notfall<\/strong> auf Basis der \u00a0exzellente \u00dcbersicht von Prof. B\u00f6nner:<\/p>\n<blockquote><p><strong>B\u00f6nner G. Der hypertensive Notfall. DMW 2017; 142: 1437-1445<\/strong><\/p><\/blockquote>\n<hr \/>\n<p><strong>Klinisches Vorgehen: <\/strong><\/p>\n<ul>\n<li>Blutdruckmessung beiderseits (beide Oberarme!), im Notfall ggf. invasive Blutdruckmessung<\/li>\n<li>Pulsstatus<\/li>\n<li>Labor: Blutbild, Elektrolyte, Kreatinin, Urinstatus, Albuminurie\/Proteinurie,\u00a0NT-proBNP, CK-CKMB, Troponin T\/I, sekund\u00e4r: TSH, Renin\/Aldosteron, Metanephrine<\/li>\n<li>EKG, Echokardiografie, R\u00f6ntgen-Thora<\/li>\n<li>Abdomensonografie, CT Thorax\/Abdomen bei V. a. Aortenaneurysma<\/li>\n<li>ggf. Augenhintergrund<\/li>\n<li>CCT bei neurologischer Symptomatik<\/li>\n<li>jeder hypertensiver Notfall muss station\u00e4r eingewiesen werden<\/li>\n<li>Transport unter \u00e4rztlicher Aufsicht<\/li>\n<li>initiale Druckentlastung des Kreislaufsystems mit\n<ul>\n<li>Nitroglycerin s. l.<\/li>\n<li>Captopril p. o.<\/li>\n<li>Urapidil langsam i. v. oder Clonidin s.c.<\/li>\n<li>cave: keine \u00fcberschie\u00dfende Druckabf\u00e4lle, akut wirkende Kalziumantagonisten (z.B. Nifedipin\/Nitrendipin 5mg p. o.\/s. l.) f\u00fchren nicht selten zu unkontrollierbaren Blutdruckabf\u00e4llen<\/li>\n<li>keine Medikamente i.m.<\/li>\n<\/ul>\n<\/li>\n<li>Substanzauswahl nach Symptomen: Nitroglycerin 0,4 mg\/Hub (bis 3-mal) s. l., Captopril 25 mg p. o., Urapidil 25 mg langsam i. v., Clonidin 0,075 mg langsam i. v.\/s. c.<\/li>\n<li>station\u00e4re Therapie:\n<ul>\n<li>engmaschiges Monitoring\/kontinuierlicher Messung\n<ul>\n<li>Blutdruck<\/li>\n<li>Atmung<\/li>\n<li>Sauerstoffs\u00e4ttigung<\/li>\n<li>EKG<\/li>\n<li>Kontrolle des W\u00e4sserungszustandes<\/li>\n<li>Pupillengr\u00f6\u00dfe<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Oberk\u00f6rperhochlagerung<\/li>\n<li>Patienten beruhigen<\/li>\n<li>vorsichtige prim\u00e4re Blutdrucksenkung ca. 25 % (diastolisch &lt; 100 \u2013 110 mmHg) in der ersten Stunde<\/li>\n<li>Injektions- oder Infusionstherapien wegen besserer Steuerbarkeit zu bevorzugen<\/li>\n<li>cave: unter i. v.-Gabe von Nitroglycerin, Furosemid oder Urapidil Risiko in bis zu 10 % der F\u00e4lle von unerw\u00fcnschten Hypotensionen (Gefahr: Myokardinfarktes, Insultes oder Nierenversagens), bei sehr ausgepr\u00e4gter Hypotension auch Sehst\u00f6rungen<\/li>\n<li>in 2.\u20136. Stunde in einem Bereich um 160\/100 mmHg<\/li>\n<li>in den Folgetagen Einstellung des Blutdruckes &lt;140\/90 mmHg)<\/li>\n<li>intraven\u00f6se Therapie bei fehlendem Therapieansprechen:\n<ul>\n<li>Nitroglycerin: 0,3 \u2013 6,0 mg\/h<\/li>\n<li>Urapidil: 7,5 \u2013 9 mg\/h (max. 30mg\/h)<\/li>\n<li>Nicardipin: 5 \u2013 15 mg\/h<\/li>\n<li>Esmolol: 0,05 \u2013 0,1 mg\/kg\/min<\/li>\n<li>Dihydralazin: 2 \u20134 mg\/h<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<p><strong>Lesen Sie den tollen Beitrag von Prof. B\u00f6nner:<\/strong><\/p>\n<blockquote><p><strong>B\u00f6nner G. Der hypertensive Notfall. DMW 2017; 142: 1437-1445<\/strong><\/p><\/blockquote>\n<hr \/>\n<p><strong><a href=\"https:\/\/twitter.com\/news_papers_eu?refsrc=email&amp;s=11\" target=\"_blank\" rel=\"noopener noreferrer\">News-Papers.eu auf TWITTER<\/a>\u00a0 \u00a0 \u00a0 \u00a0\u00a0<a href=\"http:\/\/news-papers.eu\/follow\" target=\"_blank\" rel=\"noopener noreferrer\">Follow news-papers.eu<\/a><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Nun zu Teil 3\u00a0der Serie zum\u00a0hypertensiven Notfall auf Basis der \u00a0exzellente \u00dcbersicht von Prof. B\u00f6nner: B\u00f6nner G. Der hypertensive Notfall. DMW 2017; 142: 1437-1445 Klinisches Vorgehen: Blutdruckmessung beiderseits (beide Oberarme!), [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":6403,"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":[446],"class_list":["post-6635","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-kardiovaskulaerer-notfall","tag-hypertensiver-notfall"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/11\/Blutdruck-e1511700462767.jpg?fit=300%2C200&ssl=1","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7fR2g-1J1","jetpack-related-posts":[{"id":6643,"url":"https:\/\/news-papers.eu\/?p=6643","url_meta":{"origin":6635,"position":0},"title":"Hypertensiver Notfall &#8211; Teil 4","author":"Michael Bernhard","date":"Januar 18, 2018","format":false,"excerpt":"In Teil 4 der Serie zum hypertensiven Notfall geht es heute um spezielle Therapiebedingungen: B\u00f6nner G. Der hypertensive Notfall. DMW 2017; 142: 1437-1445 Hypertensiver Notfall bei Myokardinfarkt: initiale Blutdrucksenkung um 25 % des Ausgangsdruckes diastolische Blutdruck sollte nicht zu tief abfallen und Werte bis 100 mmHg akzeptiert werden,\u00a0Grund: Sicherung der\u2026","rel":"","context":"In &quot;Kardiovaskul\u00e4rer Notfall&quot;","block_context":{"text":"Kardiovaskul\u00e4rer Notfall","link":"https:\/\/news-papers.eu\/?cat=1079"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/11\/Blutdruck-300x200.jpg?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":6632,"url":"https:\/\/news-papers.eu\/?p=6632","url_meta":{"origin":6635,"position":1},"title":"Hypertensiver Notfall &#8211; Teil 2","author":"Michael Bernhard","date":"Januar 13, 2018","format":false,"excerpt":"Nun zu Teil 2 der Serie zum\u00a0hypertensiven Notfall auf Basis der \u00a0exzellente \u00dcbersicht von Prof. B\u00f6nner: B\u00f6nner G. 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