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Propedeutica. Luc De Wolf. RZ TIENEN. From Touch to Screentouch Wrong 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. - PowerPoint PPT Presentation
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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.
ABSO
LUTE
BEN
EFIT
PER
1,
000
TREA
TED
PATI
ENTS
TREATMENT DELAY IN HOURS0 3 6 9 12 15 18 21 24
0
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!