Pacientul politraumatizat - Cursul national de ghiduri si protocoale in ...
Pacientul politraumatizat - Cursul national de ghiduri si protocoale in ...
Pacientul politraumatizat - Cursul national de ghiduri si protocoale in ...
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mai mic <strong>de</strong> 8, se impune controlul cailor aeriene, <strong>de</strong> obicei pr<strong>in</strong> <strong>in</strong>tubatieorotraheala. De asemenea, daca GCS este mai mic <strong>de</strong> 13, <strong>de</strong>v<strong>in</strong>e necesaraefectuarea examenului tomografic cranian <strong>de</strong> urgenta.Evaluarea rapida a nivelului constientei se face <strong>si</strong> pe scala AVPU:a. A = “alert” - pacient vigilb. V = “voice” - raspun<strong>de</strong> la stimul verbalc. P = “pa<strong>in</strong>” - raspun<strong>de</strong> la durered. U = “unrespon<strong>si</strong>ve” - fara raspunsO consec<strong>in</strong>ta a hipoperfuziei este alterarea statusului mental, <strong>de</strong>ci un scorGCS <strong>in</strong>itial mai mic. Dev<strong>in</strong>e astfel necesara mai <strong>in</strong>tai resuscitarea hemod<strong>in</strong>amicaprecoce urmata apoi <strong>de</strong> evaluarea neurologica. Un pacient <strong>in</strong>stabilhemod<strong>in</strong>amic nu trebuie transportat la examenul CT <strong>de</strong>cat dupa ce s-a a<strong>si</strong>guratcontrolul cailor aeriene <strong>si</strong> al respiratiei precum <strong>si</strong> dupa stabilizareastatusului circulator.Frecvent, teama <strong>de</strong> a nu <strong>in</strong>fluenta evaluarea neurologica duce la un control<strong>in</strong>a<strong>de</strong>cvat al durerii. Totu<strong>si</strong>, putem sa adm<strong>in</strong>istram un analgetic carepana <strong>in</strong>tra <strong>in</strong> actiune permite evaluarea rapida <strong>si</strong> corecta a statusului neurologic.233E (Exposure) – <strong>de</strong>zbracarea <strong>si</strong> exam<strong>in</strong>area completa a pacientuluiOrice pacient <strong>politraumatizat</strong> se exam<strong>in</strong>eaza complet <strong>de</strong>zbracat, iar <strong>in</strong>toarcerealui pentru a vizualiza <strong>si</strong> zonele dorsale se face “<strong>in</strong> bloc” cu ment<strong>in</strong>ereacoloanei cervicale <strong>in</strong> ax (fi<strong>in</strong>d necesare trei persoane pentru executareaacestei manevre). Dupa ce pacientul a fost exam<strong>in</strong>at, se iau masuri <strong>de</strong>prevenire a hipotermiei pr<strong>in</strong> acoperirea cu o patura calda.In f<strong>in</strong>al, daca este po<strong>si</strong>bil, se face o anamneza rapida, sub 5 m<strong>in</strong>ute, <strong>de</strong> lapacient, apart<strong>in</strong>atori, personalul ambulantei referitor la circumstantele acci<strong>de</strong>ntuluiprecum <strong>si</strong> <strong>de</strong>spre medicatia folo<strong>si</strong>ta anterior, ultima masa, alergiimedicamentoase cunoscute, existenta unor boli cronice asociate.De asemenea, montarea son<strong>de</strong>i ur<strong>in</strong>are <strong>si</strong> nazogastrice face parte d<strong>in</strong> cadrulevaluarii primare. Exam<strong>in</strong>area radiologica <strong>in</strong> aceasta etapa se rezuma laefectuarea a trei radiografii: toraco-pulmonara (fata), baz<strong>in</strong> (fata) <strong>si</strong> coloanacervicala (profil).Avand <strong>in</strong> ve<strong>de</strong>re toate circumstantele agravante, caracteristice pacientului<strong>politraumatizat</strong>, trebuiesc stabilite <strong>protocoale</strong> specifice pentru aceasta<strong>si</strong>tuatie. In tabelul nr. 2 este prezentat protocolul <strong>de</strong> abordare precoce <strong>in</strong>trauma multipla – Acute Trauma Sub-Algorithm. Early Management of SevereTrauma protocol (5).Timisoara 2007
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