Geschätzte Community!
Hier folgt nun der zweite Teil unserer Falldokumentation “Rasche Wendung“!
Zuletzt fand sich folgende Rhythmusstörung im Monitorauszug:
Die Notarztmannschaft entschliesst sich zur Schockabgabe mit 200J biphasisch:
Rhythmusmonioring nach der Schockabgabe:
Folgend nun einige Monitoraufzeichnungen der restlichen 15 Minuten während des Transportes bis zur Ankuft im Krankenhaus:
Besonderheiten in den 2 oben gezeigten Bildern?
Weiter geht es mit Verlaufskontrollen während des Transportes!
Letzte Monitorableitung bei der Übergabe im Krankenhaus:
Anbei noch die Ereignisdokumentation mit einer Übersicht über den zeitlichen Verlauf und die Vitalparameter (HF und RR).
Welche Erkrankung kann für die gezeigten Rhythmusstörungen verantwortlich sein?
Welche Therapie könnte angebracht sein?
Der weitere Verlauf (beim Transport) zeigt offensichtlich auch eine Rhythmusstörung. Um welche handelt es sich dabei?
Für die Übermittlung des Beispieles bedanken wir uns bei einer Notarztmannschaft aus Niederösterreich!
Falldoku des Monats: Rasche Wendung (Teil 2/2),
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durch die vorangehende bc Episode und den in den folge EKGs auffälligen p-Wellen ( nach der Schockabgabe intermittierende AV-Disoziation, dann negative p-Wellen am TR bis zur Normalisierung zu einem Sinusrhythmus) halte ich es für möglich das ein intermittierender höhergradiger AV-Block zuerst die Synkope verursacht hat und nachfolgend Extrasystolen aus tieferliegenden Ersatzzentren die Torsaden ausgelöst haben könnten. Spannender Fall!!
Was könnte ausschlaggebend für die Torsaden bzw. die AV Diss. sein? (auf den letzten Bildern kann man es evt. entdecken…). LG
trotz langem Überlegen komm ich nicht drauf… Würde mich aber freuen die Lösung zu erfahren… LG
also die QTc ist bei Bild 8, 9 und 10 normal, beim letzten leicht verlängert (≈450 ms). Was der Grund für die AV Diss. ist… k.A.
Mein vorheriger Post war vielleicht irreführend… ich meinte die Lösung liegt in Teil 1 des Beispieles =) Gibts nur wenige Gründe für Torsaden (Ischämie, E-Lyte….). die Lösung ist im ersten Teil zu finden =) LG Peter
WPW
Hyperkaliämie, daher die Torsaden?
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