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ABC - časopis urgentne medicine
2008, vol. 8, br. 1-2, str. 76-79
jezik rada: srpski
prikaz slučaja
Akutni koronarni sindrom i rana defibrilacija - da li je neophodan prehospitalni EKG monitoring?
Gradski zavod za hitnu medicinsku pomoć, Beograd

Sažetak

'Srce je previše dobro da bi umrlo' je kovanica Claude Beck-a, jednog od inovatora defibrilacije. U većini slučajeva iznenadna srčana smrt (ISS) je uzrokovana ventrikularnom fibrilacijom (VF) (85%), gde je rano primenjena defibrilacija najvažniji faktor preživljavanja tih pacijenata. Uspešnost defibrilacije opada sa svakim minutom zakašnjenja za 5-10%. VF najčešće nastaje u toku akutnog koronarnog sindroma (AKS) i akutni infarkt miokarda (AIM) je i dijagnostikovan u polovine preživelih od ISS. Iz tih razloga neophodno je na vanbolničkom nivou pri svakoj sumnji na AKS obavezno uraditi elektrokardiogram (EKG) (Klasa IIa) kao i da medicinsko osoblje zna da primeni uznapredovale tehnike održavanja života. U radu je opisan slučaj pacijenta sa VF na terenu AIM. Nakon postavljene dijagnoze AIM primenili su se aktuelni standardi za vanbolničko zbrinjavanje pacijenta sa AKS, MONA terapija uz kontinuirani EKG-monitoring pacijenta. Zahvaljujući tome brzo je utvrđena pojava fatalnog srčanog poremećaja ritma i primenjen je jedan DC šok od 360J. Rana defibrilacija je ventrikularnu aritmiju konvertovala u normalan ritam. Za ljude u srčanom zastoju rana defibrilacija (manje od 5 minuta) je najbitnija. Ono što treba da imamo na umu je da nakon uspešne defibrilacije ovi pacijenti nastavljaju da žive normalnim životom.

Ključne reči

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