2. Propedeutica Luc De Wolf

4. RZ TIENEN

5. From Touch to Screentouch Wrong direction? From the 1960 untill 2014 From Pincus to Peter Sagan From clinic to technicity

6. Keyboard The clinical examination is the keyboard to good clinical practice EINDTERMEN

7. Doelstellingen Accuratere en betere geneeskunde Minder techniciteiten Efficienter: tijd besparend Prijs- kwaliteit

8. Klinische evaluatie Anamnese : listen to the patient he will tell you the diagnosis Inspektie: l ook to the patient you will see the diagnosis Palpatie en Percussie: feel and find the diagnosis Auscultatie: listen and hear the diagnosis

9. Kliniek onderzoek tot Diagnose Diagnose -symptoom- behandeling Symptoom - diagnose- behandeling Symptoom -behandeling -diagnose

10. ACUUT-NIET ACUUT Niet vitale parameters Vitale parameters

11. Niet vitale parameters eindtermen Systematiek Modulatie Anamnese Inspectie Leeftijd Geslacht Geassocieerde pathologie

12. Vitale parameters - Anamnese :PIJN - Klinische parameters Pols Bloeddruk Ademhalingsfrequentie Bewustzijn Temperatuur

13. Anamnese Akute pijn : Thoracaal Abdominaal Cerebraal

14. Anamnese : Pijn Acuut coronair syndroom Time is muscle

17. Thrombosis Influences the Severity of a Cardiovascular Event Nonocclusive thrombusOcclusive 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:

18. 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

19. INFLUENCE OF TIME-TO-TREATMENT ON THE ODDS RATIO (OR) OF MORTALITY Boersma et al. Lancet 1996; 348: 771–775. ABSOLUTE BENEFIT PER 1,000 TREATED PATIENTS TREATMENT DELAY IN HOURS 0 36912 15 182124 0 20 40 60 80 19 PATHOPHYSIOLOGY + 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!