{"id":929,"date":"2018-03-18T04:28:49","date_gmt":"2018-03-18T03:28:49","guid":{"rendered":"http:\/\/news-papers.eu\/?p=929"},"modified":"2017-12-27T20:42:53","modified_gmt":"2017-12-27T19:42:53","slug":"mesenterialischaemie-achtung","status":"publish","type":"post","link":"https:\/\/news-papers.eu\/?p=929","title":{"rendered":"Mesenterialisch\u00e4mie: Achtung!"},"content":{"rendered":"<p style=\"text-align: justify;\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"6441\" data-permalink=\"https:\/\/news-papers.eu\/?attachment_id=6441\" data-orig-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/11\/Bauchschmerz-e1511724878383.jpg?fit=900%2C600&amp;ssl=1\" data-orig-size=\"900,600\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;4&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;Canon EOS 600D&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;18&quot;,&quot;iso&quot;:&quot;400&quot;,&quot;shutter_speed&quot;:&quot;0.033333333333333&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Bauchschmerz\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/11\/Bauchschmerz-e1511724878383.jpg?fit=300%2C200&amp;ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/11\/Bauchschmerz-e1511724878383.jpg?fit=1024%2C683&amp;ssl=1\" class=\"size-medium wp-image-6441 alignright\" src=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/11\/Bauchschmerz.jpg?resize=300%2C200\" alt=\"\" width=\"300\" height=\"200\" \/>Die <strong>Mesenterialisch\u00e4mie<\/strong> ist ein seltener, aber lebensbedrohlicher Notfall. An dieses Cham\u00e4leon muss man im Rettung- und Notarztdienst und in der Zentralen Notaufnahme einfach immer wieder denken.<\/p>\n<p style=\"text-align: justify;\">Daniel G. Clair und Kollegen beschreiben in einer aktuellen \u00dcbersichtsarbeit Aspekte der Mesenterialisch\u00e4mie:<\/p>\n<blockquote><p><strong><em>Clair DG et al., Mesenteric ischemia. NEJM 2016; 374: 959-968<\/em><\/strong><\/p><\/blockquote>\n<hr \/>\n<p>Anbei ein paar Interessante Punkte aus dem Artikel aus dem NEJM:<\/p>\n<ul>\n<li><strong>Entwicklung einer Mesenterialisch\u00e4mie:<\/strong>\u00a0wenn der mesentierale Blutfluss den metabolischen Anforderungen der viszeralen Organe nicht mehr decken kann<\/li>\n<li><strong>viele viszerale Gef\u00e4\u00dfe<\/strong> k\u00f6nnen betroffen sein (z.B. A. mesenterica superior, A. mesenterica inferior)<\/li>\n<li><strong>Frauen (70%)<\/strong> sind h\u00e4ufiger als M\u00e4nner (30%) betroffen<\/li>\n<li><strong>seltene Ursache des abdominellen Schmerzes<\/strong> mit\u00a0&lt;1 pro 1.000 Krankenhausaufnahmen (cave: nicht Vorstellungen in der Notaufnahme)\n<ul>\n<li><em>embolische Verschl\u00fcsse<\/em> der Mesenterialarterien: 40-50%<\/li>\n<li><em>thrombotische Verschl\u00fcsse<\/em> vorbestehender Stenosen der Mesenterialarterien: 20-35%<\/li>\n<li><em>ven\u00f6se Thrombose<\/em>: 5-15% (reduzierter ven\u00f6ser Abfluss, Darmschwellung, Bauchschmerz) infolge Thrombophilie, Trauma, lokale inflammatorische Prozessen (z.B. Pankreatitis, Diverticulitis, Entz\u00fcndungen im bili\u00e4ren System)<\/li>\n<li><em>Dissektionen der Mesenterialarterien<\/em>:\u00a0&lt;5%<\/li>\n<\/ul>\n<\/li>\n<li><strong>insgesamt hohe Letalit\u00e4t: 80-100%<\/strong><\/li>\n<li>akute Mesenterialisch\u00e4mie ist ein chirurgisches Krankheitsbild (DD interventionelle Angiologie\/Radiologie im interdisziplin\u00e4ren Teamansatz)<\/li>\n<li>&gt;90% der chronischen Mesenterialisch\u00e4mien liegen atherosklerotische Ver\u00e4nderungen zugrunde<\/li>\n<li><strong>NOMI:<\/strong> reduziertes &#8222;Cardiac Output&#8220; mit reduziertem meseteriellem Blutfluss<\/li>\n<li>in der <strong>Anamnese<\/strong> beachten (Mesenterialarterienembolie): andere atherosklerotische Erkrankungen, Gef\u00e4\u00dferkrankungen (inkl. periphere arterielle Verschlusserkrankungen, koronare Herzerkrankung, renovaskul\u00e4re Erkrankungen), Vorhofflimmern, Z.n. Myokardinfarkt<\/li>\n<li><strong>in der Anamnese beachten (Mesenterialthrombose):<\/strong>\n<ul>\n<li>tiefe Beinvenenthrombose<\/li>\n<li>Tumorerkrankungen<\/li>\n<li>chronische Lebererkrankungen<\/li>\n<li>Protalvenenthrombose<\/li>\n<li>Thrombophilie<\/li>\n<\/ul>\n<\/li>\n<li><strong>Symptomatik:<\/strong>\n<ul>\n<li>sehr unterschiedlich<\/li>\n<li>Abdominalschmerz<\/li>\n<li>akuter Beginn<\/li>\n<li>cave: wechselnder Schmerz<\/li>\n<li>Thrombosen scheinen einen geringeren abrupten Beginn aufzuweisen als Patienten mit Embolien<\/li>\n<\/ul>\n<\/li>\n<li><strong>Symptomatik der chronischen Mesenterialisch\u00e4mie:<\/strong>\n<ul>\n<li>sehr wechselhaft<\/li>\n<li>prostprandialer Schmerz (ca. 30-60 min nach Nahrungsaufnahme)<\/li>\n<li>\u00dcbelkeit\/Erbrechen<\/li>\n<li>Gewichtsverlust, u.a.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Labor:<\/strong>\n<ul>\n<li>Elektrolyt und S\u00e4ure-Base-Status (Azidose, Laktat)<\/li>\n<li>Infektparameter<\/li>\n<li>bisher kein sicherer Biomarker verf\u00fcgbar<\/li>\n<\/ul>\n<\/li>\n<li><strong>Diagnostik:<\/strong>\n<ul>\n<li>Sonographie<\/li>\n<li>\u00a0CT\/MRT<\/li>\n<li>Endoskopie<\/li>\n<li>Angiographie<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<blockquote>\n<p style=\"text-align: center;\"><strong>Merke: Eines der wichtigsten Aspekte ist: daran denken!<\/strong><\/p>\n<\/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<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>Die Mesenterialisch\u00e4mie ist ein seltener, aber lebensbedrohlicher Notfall. An dieses Cham\u00e4leon muss man im Rettung- und Notarztdienst und in der Zentralen Notaufnahme einfach immer wieder denken. Daniel G. Clair und [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":6441,"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}},"categories":[706],"tags":[1063,1270],"class_list":["post-929","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gefaessnotfall","tag-akutes-abdomen","tag-mesterialischaemie"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/11\/Bauchschmerz-e1511724878383.jpg?fit=900%2C600&ssl=1","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7fR2g-eZ","jetpack-related-posts":[{"id":15352,"url":"https:\/\/news-papers.eu\/?p=15352","url_meta":{"origin":929,"position":0},"title":"Akute Mesenterialisch\u00e4mie by SOP-Notaufnahme.de","author":"Michael Bernhard","date":"April 17, 2022","format":false,"excerpt":"news-papers.eu hatte unl\u00e4ngst auf die zwei Kollegen Marc Baier und Juri Mattern von https:\/\/sop-notaufnahme.de\u00a0mit der Mission:\u00a0SOPs f\u00fcr die Notaufnahme hingewiesen.\u00a0Herzlichen Dank f\u00fcr die tolle Resonanz f\u00fcr die beiden Kollegen.\u00a0Anbei das neuste Werk die SOP Mesenterialisch\u00e4mie: \u00a0","rel":"","context":"In &quot;Gef\u00e4\u00dfnotfall&quot;","block_context":{"text":"Gef\u00e4\u00dfnotfall","link":"https:\/\/news-papers.eu\/?cat=706"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2022\/04\/Bildschirmfoto-2022-04-07-um-21.36.13.png?fit=1200%2C560&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2022\/04\/Bildschirmfoto-2022-04-07-um-21.36.13.png?fit=1200%2C560&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2022\/04\/Bildschirmfoto-2022-04-07-um-21.36.13.png?fit=1200%2C560&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2022\/04\/Bildschirmfoto-2022-04-07-um-21.36.13.png?fit=1200%2C560&ssl=1&resize=700%2C400 2x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2022\/04\/Bildschirmfoto-2022-04-07-um-21.36.13.png?fit=1200%2C560&ssl=1&resize=1050%2C600 3x"},"classes":[]},{"id":7016,"url":"https:\/\/news-papers.eu\/?p=7016","url_meta":{"origin":929,"position":1},"title":"Swiss Trauma &#038; Acute Care Surgery Days 2018","author":"Michael Bernhard","date":"Februar 2, 2018","format":false,"excerpt":"Am 16. und 17. M\u00e4rz veranstaltet die Swiss Association for Trauma & Acute Care Surgery bereits zum 7. Mal die Swiss Trauma & Acute Care Surgery Days. An zwei Tagen wird durch ein internationales und interdisziplin\u00e4res Team an Referenten ein breites und interessantes Spektrum an Vortr\u00e4gen und Workshops rund um\u2026","rel":"","context":"In &quot;Veranstaltungshinweis&quot;","block_context":{"text":"Veranstaltungshinweis","link":"https:\/\/news-papers.eu\/?cat=30"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2018\/01\/Bildschirmfoto-2018-01-29-um-10.24.56.png?fit=768%2C358&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2018\/01\/Bildschirmfoto-2018-01-29-um-10.24.56.png?fit=768%2C358&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2018\/01\/Bildschirmfoto-2018-01-29-um-10.24.56.png?fit=768%2C358&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2018\/01\/Bildschirmfoto-2018-01-29-um-10.24.56.png?fit=768%2C358&ssl=1&resize=700%2C400 2x"},"classes":[]},{"id":2871,"url":"https:\/\/news-papers.eu\/?p=2871","url_meta":{"origin":929,"position":2},"title":"Sieht aus wie Sepsis &#8211; Ist aber keine Sepsis &#8230;","author":"Michael Bernhard","date":"Januar 15, 2017","format":false,"excerpt":"Sepsis Mimics:\u00a0Sieht aus wie Sepsis - Ist aber keine Sepsis ... Brit Long und Kollegen haben im Journal of Emergency Medicine einen exzellenten Artikel zu dieser Thematik publiziert: Long B et al., Clinical mimics: An emergency medicine-focused review of sepsis mimics. JEM 2016,\u00a0http:\/\/dx.doi.org\/10.1016\/j.jemermed.2016.07.102 In diesem Artikel stellt Brit Long ein\u2026","rel":"","context":"In &quot;Sepsis&quot;","block_context":{"text":"Sepsis","link":"https:\/\/news-papers.eu\/?cat=57"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Sepsis.jpg?fit=900%2C1200&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Sepsis.jpg?fit=900%2C1200&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Sepsis.jpg?fit=900%2C1200&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/02\/Sepsis.jpg?fit=900%2C1200&ssl=1&resize=700%2C400 2x"},"classes":[]},{"id":1348,"url":"https:\/\/news-papers.eu\/?p=1348","url_meta":{"origin":929,"position":3},"title":"Zikavirus &#8211; eine \u00dcbersicht","author":"Michael Bernhard","date":"Mai 20, 2016","format":false,"excerpt":"In einer aktuellen \u00dcbersichtsarbeit bieten Lyle R. Petersen et al. sehr interessante Informationen und eine gute Zusammenfassung zur Epidemiologie, Transmission, Diagnose und Behandlung der aktuell insbesondere aus dem Medien bekannten Flavivirus \"Zikavirus\". Petersen LR, et al. Zika Virus. NEJM 2016; 374: 1552-1563 (PDF) Erg\u00e4nzende Informationen erhalten Sie \u00fcber: Centers for\u2026","rel":"","context":"In &quot;Infektionen&quot;","block_context":{"text":"Infektionen","link":"https:\/\/news-papers.eu\/?cat=5"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/04\/Bildschirmfoto-2016-04-21-um-09.51.34.png?fit=682%2C326&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/04\/Bildschirmfoto-2016-04-21-um-09.51.34.png?fit=682%2C326&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/04\/Bildschirmfoto-2016-04-21-um-09.51.34.png?fit=682%2C326&ssl=1&resize=525%2C300 1.5x"},"classes":[]},{"id":15086,"url":"https:\/\/news-papers.eu\/?p=15086","url_meta":{"origin":929,"position":4},"title":"\u201eMust reads\u201c der vergangenen Wochen","author":"Michael Bernhard","date":"Februar 9, 2022","format":false,"excerpt":"Ein Beitrag von PD Dr. Knapp, Schweiz Einen schnellen und guten \u00dcberblick \u00fcber die Neuerungen der neuen Sepsis-Leitlinien bietet der Artikel von Prof. Briegel und PD Dr. M\u00f6hne aus M\u00fcnchen: Briegel J et al. Update der Surviving-Sepsis-Campaign-Leitlinie 2021\u00a0\u2013 Was ist neu? An\u00e4sthesist 2022, online\u00a0https:\/\/link.springer.com\/article\/10.1007\/s00101-022-01087-x Besser Ketamin zur Notfallnarkose als Etomidate:\u2026","rel":"","context":"In &quot;Notaufnahme&quot;","block_context":{"text":"Notaufnahme","link":"https:\/\/news-papers.eu\/?cat=2083"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2017\/11\/Bildschirmfoto-2017-11-05-um-08.40.27-300x110.png?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":2381,"url":"https:\/\/news-papers.eu\/?p=2381","url_meta":{"origin":929,"position":5},"title":"RESCUE-ICP Studie","author":"Michael Bernhard","date":"November 7, 2016","format":false,"excerpt":"Am 07.09.2016 wurde im New Englang Journal of Medicine der RESCUE-ICP (Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation\u00a0of Intracranial Pressure) Studie\u00a0publiziert: Hutchinson PJ, et al. Trial of Decompressive Craniectomy\u00a0for Traumatic Intracranial Hypertension. NEJM 2016;\u00a0DOI: 10.1056\/NEJMoa1605215 und von einem Editorial begleitet: Shutter L, et al. Intracranial Pressure Rescued by\u2026","rel":"","context":"In &quot;Trauma&quot;","block_context":{"text":"Trauma","link":"https:\/\/news-papers.eu\/?cat=6"},"img":{"alt_text":"OP","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/NCH-OP.jpg?fit=900%2C1200&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/NCH-OP.jpg?fit=900%2C1200&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/NCH-OP.jpg?fit=900%2C1200&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/NCH-OP.jpg?fit=900%2C1200&ssl=1&resize=700%2C400 2x"},"classes":[]}],"jetpack_likes_enabled":true,"_links":{"self":[{"href":"https:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts\/929","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=929"}],"version-history":[{"count":9,"href":"https:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts\/929\/revisions"}],"predecessor-version":[{"id":6871,"href":"https:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts\/929\/revisions\/6871"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/media\/6441"}],"wp:attachment":[{"href":"https:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=929"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=929"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=929"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}