PRECLINICAL MANAGEMENT OF THROMBOEMBOLIC DISORDERS

Preclinical management faces considerable diagnostic and therapeutic l imitations. Patient history, physical examination, and few technical m eans (electrocardiogram [ECG], blood glucose measurement) must suffice to arrive at a suspected or definite diagnosis. Emergency treatment o f most medical conditions inside the hospital differs from the preclin ical setting. Critically ill patients must be transported to the hospi tal in emergency units with standardized equipment. Diagnosis of acute myocardial infarction relies on patient history, present symptoms, an d a 12-lead ECG, and can be made with relative certainty. Therapeutic management focuses on reduction of myocardial oxygen consumption and o ptimizing oxygen availability. Monitoring for possible arrhythmias is essential. Few exceptional situations justify preclinical thrombolytic therapy. After a neurologic deficit has been diagnosed, the managemen t of patients with stroke includes support of vital functions and admi ssion to a hospital where computed tomography or magnetic resonance im aging is available. Pulmonary thromboembolism is frequently misdiagnos ed even in the hospital. Preclinical physical examination, patient his tory, ECG, and pulse oximetry allow a positive diagnosis only in massi ve embolization. Anticoagulation with heparin is essential. If cardiop ulmonary resuscitation is necessary, preclinical thrombolysis may be a n option. Although deep vein thrombosis is difficult to recognize, cla ssical symptoms of acute arterial occlusion are rarely missed. Treatme nt consists of general measures and anticoagulation.