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Propedeutica

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.

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Propedeutica

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  1. Propedeutica Luc De Wolf

  2. RZ TIENEN

  3. From Touch to ScreentouchWrong direction? From the 1960 untill 2014 From Pincus to Peter Sagan From clinic to technicity

  4. Keyboard • The clinical examination is the keyboard to good clinical practice EINDTERMEN

  5. Doelstellingen • Accuratere en betere geneeskunde • Minder techniciteiten • Efficienter: tijd besparend • Prijs- kwaliteit

  6. 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

  7. Kliniek onderzoek tot Diagnose • Diagnose -symptoom- behandeling • Symptoom - diagnose- behandeling • Symptoom -behandeling -diagnose

  8. ACUUT-NIET ACUUT Niet vitale parameters Vitale parameters

  9. Niet vitale parameterseindtermen • Systematiek • Modulatie • Anamnese • Inspectie • Leeftijd • Geslacht • Geassocieerde pathologie

  10. Vitale parameters - Anamnese :PIJN - Klinische parameters • Pols • Bloeddruk • Ademhalingsfrequentie • Bewustzijn • Temperatuur

  11. Anamnese • Akute pijn : Thoracaal • Abdominaal • Cerebraal

  12. Anamnese : Pijn • Acuut coronair syndroom • Time is muscle

  13. Nonocclusive thrombus Occlusive thrombus Thrombosis Influences the Severity of a Cardiovascular Event • Unstable angina • Non—Q-wave MI • Q-wave MI • Sudden death Factors limiting thrombosis: Factors favoring thrombosis: • 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.

  14. 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

  15. INFLUENCE OF TIME-TO-TREATMENT ON THE ODDS RATIO (OR) OF MORTALITY 19 80 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! PATHOPHYSIOLOGY + 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 60 ABSOLUTE BENEFIT PER 1,000 TREATED PATIENTS 40 20 0 15 3 6 9 12 18 21 24 0 TREATMENT DELAY IN HOURS Boersma et al. Lancet 1996; 348: 771–775.

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