Johannes Mair und Otmar Pachinger
Myokardinfarkterstversorgung im Gebirge – Eine kritische Betrachtung zum Stellenwert der präklinischen Lysetherapie Emergency Care of Acute Myocardial Infarctions in the Mountains – A Critical Appraisal of Preclinical Fibrinolytic Therapy S U M M A RY If the emergency care of an acute myocardial infarction (AMI) is possible by calling a helicopter with an emergency physician on board the treatment must follow the current state-of-the art. For the subsequent patient management it is essential whether the initial electrocardiogram (ECG) shows ischemia-typical ST-segment elevations or not. Therefore, a 12-lead standard ECG should be recorded on the scene of the action if possible. In the presence of typical STsegment elevations (STEMI) the nearest department of cardiology with the possibilities for acute coronary interventions (PCI) should be contacted immediately to coordinate further therapy and management. If the contact-to balloon time for mechanical reperfusion therapy is likely to be <90 minutes primary PCI is the therapy of choice and the patient must be transported to the centre without unnecessary delay. If this cannot be guaranteed and there are no contraindications preclinical thrombolytic treatment is a very good treatment option, particularly in patients presenting within 2–3 hours from symptom onset. These patients should also be transported to the department of cardiology to allow a ”rescue“-PCI in case of treatment failure without further delay. Additional indications for preclinical thrombolytic therapy are large AMI with impending or manifest cardiogenic shock or "rescue" thrombolysis after initially failed resuscitation. Key words: myocardial infarction, management, mountain, acute percutaneous coronary intervention, preclinical fibrinolytic therapy
Z U S A M M E N FA S S U N G Ist die Erstversorgung eines Herzinfarktpatienten im Gebirge durch Anforderung eines Rettungshubschraubers mit Notarztbegleitung möglich, so sollte
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