Präklinisches Management und Therapie des epileptischen Anfalls und des Status epilepticus

Zusammenfassung

Epilepsie ist eine der häufigsten neurologischen Erkrankungen im Erwachsenenalter und eine der häufigsten Diagnosen in neurologischen Kliniken. Im Rettungswesen werden epileptische Anfälle oder klinisch ähnlich suspekte Ereignisse, die nicht zwingend epileptisch sein müssen, unter der Meldediagnose “Krampfanfall” geführt. Eine sichere diagnostische Einschätzung am Notfallort ist für die Mitarbeiter der Rettungsteams oft erschwert, da Patienten im oder nach einem Anfall oft noch verwirrt sein können, oder zum Ereignis eine Amnesie zeigen. Fehldiagnosen liegen bei ca. 30%. Folge kann eine Überoder Unterversorgung der Betroffenen sein, die im ungünstigsten Fall eine erhöhte Morbidität oder Mortalität nach sich ziehen kann. Eine verbesserte präklinische diagnostische Einschätzung kann das weitere therapeutische Prozedere steuern. Neben einer medikamentösen Notfalltherapie kommt der Ersten Hilfe und den Basismaßnahmen durch Laienhilfe oder Rettungsdienste eine wichtige Rolle zu.

Summary

In adult neurology, epilepsy is one of the most common chronic neurological diseases. Also it is one of the most frequent diagnoses in a neurological hospital unit. Epileptic seizures and paroxysmal events, which have the potential to be categorized as epileptic in the clinical context, are labelled and communicated as “fit” in the emergency service. Making an accurate diagnosis is often difficult for the emergency team, e.g. because the patient is postictally amnesic or confused. The rate of misdiagnosis is estimated up to 30%. Misdiagnosis can results in both overand undertreatment of the patient, which could lead to an increased morbidity and mortality under unfavorable circumstances. An optimized pre-hospital management could modify succeeding therapeutic procedures. Aside possible emergency therapy, first aid and other interventions from lay people or paramedics have considerable importance.

Schlüsselwörter

Prähospitales Management - Notfalltherapie - Anfall - Anfallsserie - Status epilepticus - Epilepsie

Keywords

Prehospital - emergency care - management - seizure - epilepsy - treatment

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