Asthma bronchiale - Notfallmedizinische Versorgung

 

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Zusammenfassung

Die Versorgung von Asthmapatienten mit lebensbedrohlichen Anfällen ist eine Herausforderung für den Notfallmediziner. Die schnelle und korrekte Therapie, basierend auf inhalativen β₂-Mimetika und Anticholinergika kombiniert mit systemischen Glukokortikoiden verhindert meist fatale Verläufe. Bei Nichtansprechen müssen zusätzlich systemische β₂-Mimetika, MgSO₄ und evtl. Theophyllin zur Anwendung kommen, um eine Intubation und invasive Beatmung möglichst zu vermeiden.

Die Patienten - und insbesondere jene mit Risikofaktoren für einen fatalen Verlauf - müssen bis zur Beschwerdefreiheit unter Beobachtung bleiben. Leichte und mittelschwere Anfälle können bei Erreichen von Beschwerdefreiheit ambulant versorgt werden. Im Rettungsdienst muss die Beobachtungszeit bis zur Beschwerdefreiheit gewährleistet sein, ansonsten sollten die Patienten in das nächstgelegene geeignete Krankenhaus transportiert und in der Notaufnahme vorgestellt werden.

Abstract

Treatment of patients with acute severe or life-threatening asthma in the emergency department or in rescue services is a challenge for the physician. The decision on which therapy is needed depends on the clinical assessment of severity. Early administration of bronchodilators, ipratropium bromide and oral or intravenous corticosteroids is the cornerstone of treatment. If these treatments fail, systemic administration of bronchodilators, MgSO4 and theophylline should be carried in order to avoid intubation. Patients with incomplete or poor response should stay in hospital.

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