Author/Editor		Kovač, Miha
Title		Ukrepi na terenu pri bolnikih z akutno možgansko kapjo
Translated title		Management of an acute stroke in pre-hospital setting
Type		članek
Source		Zdrav Vars
Vol. and No.		Letnik 38, št. 9-10
Publication year		1999
Volume		str. 302-4
Language		slo
Abstract		In 1998, pre-hospital emergency doctors in Ljubljana treated 175 patients diagnosed with a transient ischaemic attack and 497 patients diagnosed with cerebrovascular insult. With the introduction of thrombolytic medication the treatment of a stroke became very similar to the treatment of a heart attack. The penumbra (compromized tissue in a zone of reduced blood flow) is viable for up to several hours. Despite frequent complications (bleedings) the results are favourable. The therapeutic window is extremel narrow, there are only three hours on disposal for a successful use of throm bolytics. Every link in the chain of survival must be optimal. The patient should recognise the symptoms of the stroke immediately and activate pre-hospital emergency units which must react right away and after having given full pre-hospital care, hand the patient over to the admitting neurologist. The neurologist must use all necessary diagnostic methods and apply thrombolytic medication if indicated. At present this chain has still many weak links. It will prob- ably be easier to strengthen the pre-hospital treatment since already now the field care of a patient with a stroke practically dnesn't differ from the indicated directions.
Summary		V letu 1998 smo na SNMP v Ljubljani obravnavali 175 bolnikov z diagnozo tranzitorna ishemična ataka in 497 bolnikov z diagnozo cerebrovaskularni inzult. Z uvedbo trombolitičnih zdravil se je zdravljenje možganske kapi močno približalo zdravljenju srčne kapi, ko z raztapljanjem strdka ponovno vzpostavimo normalen krvni pretok skozi prizadeto, vendar še ne odmrlo tkivo (ypenumbrar). Kljub pogostim zapletom (krvavitve) so rezultati vzpodbudni in nas silijo v drugačen način razmišljanja o zdravljenju možganske kapi. Terapevtsko okno je izredno ozko, za uspešno uporabo trombolitikov imamo na razpolago samo tri ure. Vsak člen v verigi preživetja mora biti optimalen. Bolnik in svojci morajo takoj prepoznati znake kapi in aktivirati predbolnišnične urgentne službe, ki se morajo takoj odzvati in bolnika hitro ob popolni predbolnišnični oskrbi predati sprejemnemu nevrologu. Le-ta mora takoj uporabiti vse potrebne diagnostične metode, vključno s CT, in ob izpolnjenih pogojih dati trombolitično zdravilo. Trenutno ima opisana veriga še mnogo krhkih členov. Verjetno bomo najlažje in najhitreje okrepili predbolnišničnega, kajti oskrba bolnika z možgansko kapjo se na terenu že zdaj praktično ne razlikuje od nakazanih smernic.
Descriptors		CEREBROVASCULAR DISORDERS CEREBRAL ISCHEMIA EMERGENCIES EMERGENCY MEDICAL SERVICES