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PropedeuticaLuc De Wolf
RZ TIENEN
From Touch to ScreentouchWrong direction?
From the 1960 untill 2014
From Pincus to Peter Sagan
From clinic to technicity
Keyboard
• The clinical examination is the keyboard
to good clinical practice
EINDTERMEN
Doelstellingen
• Accuratere en betere geneeskunde
• Minder techniciteiten
• Efficienter: tijd besparend
• Prijs- kwaliteit
Klinische evaluatie
• Anamnese :listen to the patient he will tell you the diagnosis
• Inspektie: look to the patient you will see the diagnosis
• Palpatie en Percussie:feel and find the diagnosis
• Auscultatie: listen and hear the diagnosis
Kliniek onderzoek tot Diagnose
• Diagnose -symptoom- behandeling
• Symptoom - diagnose- behandeling
• Symptoom -behandeling -diagnose
ACUUT-NIET ACUUT
Niet vitale parameters Vitale parameters
Niet vitale parameterseindtermen
• Systematiek• Modulatie
• Anamnese• Inspectie• Leeftijd• Geslacht• Geassocieerde pathologie
Vitale parameters
- Anamnese :PIJN - Klinische parameters
• Pols
• Bloeddruk
• Ademhalingsfrequentie
• Bewustzijn
• Temperatuur
Anamnese
• Akute pijn : Thoracaal
• Abdominaal
• Cerebraal
Anamnese : Pijn
• Acuut coronair syndroom
• Time is muscle
AtheroscleroseAtherosclerose
EndotheeldysfunctieVanaf 1° decennium Vanaf 3° decennium Vanaf 4° decennium
Groei door lipidenopstapelingGlad spier-weefsel
en collageen
Thrombose,hematoom
Thrombosis Influences the Severity of a Cardiovascular Event
Nonocclusive thrombus Occlusive thrombus
• Unstable angina• Non—Q-wave MI
• Q-wave MI• Sudden death
• Minor plaque disruption
• High flow• Low thrombotic
tendency
• Major plaque disruption• Low flow or vasospasm• Thrombotic tendency
Kullo IJ, et al. Ann Intern Med. 1998;129:1050-1060.
Factors favoring thrombosis:Factors limiting thrombosis:
Progression of the disease ACS Troponine –
Stable angina exercise
Unstable angina rest prolonged progressive
Troponine +Nstemi ST segment depression
Neg T wave
Stemi ST segment elevation
INFLUENCE OF TIME-TO-TREATMENT ON THE ODDS RATIO (OR) OF MORTALITY
Boersma et al. Lancet 1996; 348: 771–775.
AB
SOLU
TE B
ENEF
IT P
ER
1,00
0 TR
EATE
D P
ATIE
NTS
TREATMENT DELAY IN HOURS
0 3 6 9 12 15 18 21 240
20
40
60
80
19PATHOPHYSIOLOGY + EPIDEMIOLOGY
THROMBOLYSIS IN CLINICAL TRIALS AND REGISTRIES
NEW TRIALS/ REGISTRIES
MANAGEMENT OF ACUTE MI AND THE RATIONALE FOR EARLY REPERFUSION
CLINICAL QUESTIONS
METALYSE (+ PRESCRIBING INFORMATION)
COSTS
REFERENCES
SYSTEM REQUIREMENTS
IMPRESSUM
The “golden hour”: 65 lives are saved for every 1,000 patients treated when the treatment is initiated within the first hour of symptom onset!