Protocol de abordare a durerii toracice in urgenta - Cursul national ...
Protocol de abordare a durerii toracice in urgenta - Cursul national ...
Protocol de abordare a durerii toracice in urgenta - Cursul national ...
- No tags were found...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
61. Se <strong>de</strong>ci<strong>de</strong> <strong>in</strong>ternarea <strong>in</strong> spital sau ment<strong>in</strong>erea sub observatie.Pacientii cu durere toracica datorata afectiunilor pleurale sau ale parenchimuluipulmonar vor fi <strong>in</strong>ternati <strong>in</strong> functie <strong>de</strong> stabilitatea pacientului.Vor fi evaluate frecventa cardiaca, frecventa respiratorie, tensiunea arterialasi nivelul <strong>de</strong> constienta. Si alti factori vor fi luati <strong>in</strong> consi<strong>de</strong>rare <strong>in</strong> <strong>de</strong>cizia <strong>de</strong><strong>in</strong>ternare, respectiv: varsta, afectiuni preexistente, starea <strong>de</strong> imuno<strong>de</strong>presieeventual ale pacientului. Daca pacientul este <strong>in</strong>stabil hemod<strong>in</strong>amic sau curisc <strong>de</strong> a <strong>de</strong>veni <strong>in</strong>stabil va fi <strong>in</strong>ternat.62. Semnele, simptomele sugereaza o durere <strong>de</strong> perete toracic/costocondrita.Costrocondrita, nevralgia <strong>in</strong>tercostala sau alte dureri musculoscheletaresunt <strong>de</strong>stul <strong>de</strong> frecvente <strong>in</strong> etiologia <strong>durerii</strong> <strong>toracice</strong>. In aceste situatii pacientulpoate localiza durerea, care se refera la o arie <strong>de</strong>stul <strong>de</strong> precisa atoracelui. Examenul fizic va i<strong>de</strong>ntifica sediul <strong>durerii</strong> si va reproduce <strong>de</strong> obiceidurerea pr<strong>in</strong> palpare.63. Tratamentul pentru durerea <strong>de</strong> perete toracic si cea d<strong>in</strong> costocondritava fi efectuat cu anti<strong>in</strong>flamatorii nesteroidiene, iar <strong>in</strong> cazul unei dureri cronicese vor aplica recomandarile pentru managementul <strong>durerii</strong> cronice.64. Afectiune <strong>in</strong> sfera gastro-<strong>in</strong>test<strong>in</strong>ala?Daca au fost excluse cauzele <strong>in</strong>tra-<strong>toracice</strong> ale unei dureri <strong>toracice</strong>, cl<strong>in</strong>icianulse poate orienta spre o afectiune d<strong>in</strong> sfera digestiva cu rasunet asupratoracelui (ex. spasmul esofagian, esofagita, boala ulceroasa gastro-duo<strong>de</strong>nala,pancreatita, colecistita).65. Evaluare d<strong>in</strong> punct <strong>de</strong> ve<strong>de</strong>re gastro-enterologic, eventual consultgastro-enterologic.In cazul <strong>in</strong> care anamneza, examenul fizic si rezultatele <strong>de</strong> laborator vororienta medicul catre o afectiune gastro<strong>in</strong>test<strong>in</strong>ala se vor urmari pasii ghidurilorspecifice bolilor gastro-<strong>in</strong>test<strong>in</strong>ale.66. Reconsi<strong>de</strong>rati diagnosticul diferential.Nici unul d<strong>in</strong> diagnosticele anterioare nu a fost confirmat, <strong>in</strong> consec<strong>in</strong>tamedicul <strong>de</strong> <strong>urgenta</strong> va reconsi<strong>de</strong>ra examenul cl<strong>in</strong>ic si paracl<strong>in</strong>ic al pacientuluicu durere toracica.613Propunerea acestui protocol <strong>de</strong> <strong>abordare</strong> a pacientului cu durere toracicaare drept scop pr<strong>in</strong>cipal <strong>abordare</strong>a corecta si complexa a unei situatii cepoate avea cauze cardiace sau non-cardiace, unele implicand un risc vital <strong>in</strong>absenta diagnosticului si tratamentului <strong>de</strong> <strong>urgenta</strong>. Un raport <strong>de</strong> audit asupra<strong>de</strong>partamentelor <strong>de</strong> <strong>urgenta</strong> d<strong>in</strong> Marea Britanie a aratat ca 7 % d<strong>in</strong>trepacientii cu durere toracica externati d<strong>in</strong> <strong>de</strong>partamentul <strong>de</strong> <strong>urgenta</strong> prezentauo afectare miocardica severa (15). Pentru a reduce cat mai mult acestTimisoara 2009
Change language