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.

AB

SOLU

TE B

ENEF

IT P

ER

1,00

0 TR

EATE

D P

ATIE

NTS

TREATMENT DELAY IN HOURS

0 3 6 9 12 15 18 21 240

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!