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Notfallmedizin up2date 2023; 18(04): 395-418
DOI: 10.1055/a-1980-0164
Internistische Notfälle

Hämatologische und onkologische Notfälle

Leo Benning
,
Sophie Giesler
,
Julian Krehl
,
Robert Zeiser
,
Hans-Jörg Busch
,
Felix Patricius Hans
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Maligne Erkrankungen zählen zu den wesentlichen Treibern der globalen Krankheitslast und betreffen insbesondere ältere Patienten. Für die Akut- und Notfallversorgung ist es daher wichtig, ein Verständnis des Spektrums möglicher Komplikationen zu entwickeln und einen praktikablen Ansatz zur Versorgung dieser Patienten zu entwickeln. Dieser Beitrag gibt einen Überblick über die wichtigsten Komplikationen und Symptome.
Kernaussagen

  • Auf die Besonderheiten von Patienten mit bestehenden und bislang nicht vorbekannten Erkrankungen aus dem hämatologisch-onkologischen Spektrum und die besondere Vulnerabilität dieser Patienten ist unbedingt zu achten.

  • Der Rettungsdienst kann konfrontiert werden mit

    • lokalen Komplikationen der malignen Erkrankung,

    • systemischen Komplikationen wie thromboembolischen Ereignissen, Blutbildveränderungen und Elektrolytstörungen,

    • therapieassoziierten Komplikationen.

  • Eine leitsymptombasierte Vorgehensweise kann helfen, die Komplexität der Grunderkrankung sowie des jeweiligen therapeutischen Regimes zu beherrschen und ein zielorientiertes Vorgehen in der Akutversorgung zu etablieren.

  • Entscheidend ist, hämatologisch-onkologische Krankheitsbilder und damit verbundene Komplikationen bei der differenzialdiagnostischen Abklärung zu bedenken und deren Dringlichkeit korrekt einzuschätzen. So stellt beispielsweise der Befund einer subsegmentalen Lungenarterienembolie in einer Staging-Bildgebung bei einem asymptomatischen Patienten eine grundlegend andere Situation dar als der akute und ohne adäquates Trauma einsetzende Rückenschmerz.

  • Gleichzeitig sollte die frühzeitige, hämatologisch-onkologische Rücksprache gesucht werden, um die rasche und zielgerichtete Weiterbetreuung im Anschluss an die Akutsituation gewährleisten zu können.

Schlüsselwörter

Tumorlysesyndrom - Rückenmarkkompression - Thromboembolie - Einflussstauung - Thrombopenie - Notfallmedizin - Krebserkrankung


Publication History

Article published online:
05 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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