Synkopen – Diagnose und Risikostratifikation

Zusammenfassung

Synkopen sind häufige Einsatzanlässe im Notarztdienst. Die Diagnosestellung ist meist nicht schwierig, da dieses Krankheitsbild klar definiert und gegen andere Entitäten abgegrenzt ist. Die häufigste Differenzialdiagnose ist der Krampfanfall, der durch die Phase der Desorientierung gut von einer Synkope unterschieden werden kann. Die Mehrzahl der Synkopen ist ungefährlich, in einigen Fällen liegen jedoch lebensgefährliche Erkrankungen zugrunde. Diese Unterscheidung ist nicht immer einfach. Die mit Abstand gefährlichsten Synkopen haben rhythmogene und andere kardiogene Ursachen. Die wichtigste apparative Untersuchung ist das 12-Kanal-EKG, das so früh wie möglich geschrieben werden sollte. Dem Notarzt kommt durch seine Feststellungen und Untersuchungen vor Ort sowie durch die Bahnung des weiteren Patientenwegs eine Schlüsselrolle bei Synkopen zu.

Abstract

Syncope is a common cause for EMS calls. Diagnosing syncope is easy in most cases because this condition is well defined and can be separated from other illnesses. The most common differential diagnosis is epileptical seizure. The distinction can be made by a postictal period of disorientation which can't be found after syncope. In most cases syncope is not dangerous but sometimes a life threatening condition can be present. Recognising them can be difficult at times. Syncope by a rhythmogenic or other cardiac origin is the most dangerous one by far. The single most important diagnostic study is a 12-lead-EKG which should be obtained at the earliest time possible. The findings and decisions by EMS physicians may be pivotal for the further course of the patient.

Schlüsselwörter

Synkope - Notarztdienst - Risikostratifizierung

Keywords

syncope - Emergency Medical Service - risk stratification

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