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Náhlá smrt je neočekávané úmrtí z netraumatických příčin do 1 h od prvních příznaků. (V některých epidemiologických studiích je definice rozšířena do 6 h (WHO) nebo až do 24 h od začátku příznaků.)

Etiopatogeneze: více než 90 % náhlých smrtí je náhlá srdeční smrt. Nejčastější chorobné stavy, vedoucí k náhlé smrti: chronická dysfunkce (či aneuryzma) levé komory po předchozím infarktu myokardu (IM), přechodná ischémie myokardu, akutní IM. Jiné příčiny (plicní embolie, mozková cévní příhoda, stenóza aorty, hypertrofická kardiomyopatie, preexcitační syndromy, aneuryzma aorty atd.) jsou mnohem vzácnější příčinou náhlé smrti mimo nemocnici (zcela jiná je situace u hospitalizovaných nemocných, upoutaných na lůžko, u nichž podíl plicní embolie je velmi podstatný). Mechanismem náhlé smrti (terminální porucha rytmu) je nejčastěji:

fibrilace komor:

mnohem vzácněji asystolie:

a mimo nemocnici jen zcela výjimečně elektromechanická disociace:

Diagnóza: bezvědomí, absence dýchání, nehmatný tep na velkých tepnách, absence event. traumatu.

Terapie: po rychlém stanovení diagnózy (pokud není pacient jednoznačně prokazatelně ve stadiu ireverzibilní smrti) se léčebný zásah řídí zjištěným srdečním rytmem. Při fibrilaci komor se provádí okamžitá elektrická defibrilace (1. výboj 200 J, pokud trvá fibrilace komor, ihned 2. výboj 200 J, pokud i poté trvá fibrilace, ihned 3. výboj 360 J), kterou při rezistentní (navzdory defibrilaci přetrvávající) fíbrilaci komor doplníme o podání mezokainu 100 mg i.v. event. adrenalinu 1 mg i.v. (samozřejmě se též do obnovy oběhu provádí neodkladná resuscitace). Při asystolii ihned zahájíme neodkladnou resuscitaci a pokusíme se o farmakologickou obnovu srdečního rytmu (Adrenalin 1-3 mg i.v., Atropin 2-3 mg i.v.). Při asystolii lze zkusit též transtorakální kardiostimulaci, její účinek je však většinou nedostatečný. Při elektromechanické disociaci se musíme pokusit zjistit a event., je-li to možné, odstranit její příčinu, jinak jsou léčebné vyhlídky mizivé. Více podrobností o neodkladné resuscitaci je na jiném místě této monografie.

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