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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238MembreLeziuni parti moiDeformari osoaseAnomalii articulareDeficite vasculare<strong>si</strong> nervoaseInspectiePalpareE<strong>de</strong>m, echimoze,paliditateDeformareDurere, sen<strong>si</strong>bilitate,crepitatiiAbsenta/dim<strong>in</strong>uarepulsPre<strong>si</strong>ne crescuta<strong>in</strong> compartimentmuscularDeficit neurologicRx. specificeEx. DopplerPre<strong>si</strong>une <strong>in</strong>compartimentAngiografie1. Evaluarea secundara a regiunii cefaliceIn aceasta etapa trebuie facut un examen neurologic complet cu apreciereascorului Glasgow, a aspectului <strong>si</strong> reactivitatii pupilelor, precum <strong>si</strong> i<strong>de</strong>ntificarea<strong>de</strong> <strong>de</strong>ficite motorii focale. Daca pe parcursul evaluarii, starea pacientului se<strong>de</strong>terioreaza (apare hipoxia sau hipoten<strong>si</strong>unea), atunci trebuie reluata evaluareaprimara <strong>si</strong> aplicarea imediata a masurilor terapeutice ce se impun.Gravitatea unui traumatism craniocerebral (TCC) se cuantifica dupa scorulGlasgow (vezi tabel 1):• TCC usor - GCS <strong>in</strong>tre 12-15• TCC mediu – GCS <strong>in</strong>tre 9-11• TCC sever – GCS sub 9Deoarece <strong>in</strong> cazul unui traumatism craniocerebral leziunea cerebrala primara(aparuta <strong>in</strong> momentul impactului) nu are caracter rever<strong>si</strong>bil, scopulpr<strong>in</strong>cipal al terapiei este <strong>de</strong> a preveni sau <strong>de</strong> a m<strong>in</strong>imiza aparitia <strong>de</strong> leziunisecundare cerebrale. Prezenta concomitenta a hipoten<strong>si</strong>unii arteriale <strong>si</strong>/saua hipoxiei creste riscul <strong>de</strong> mortalitate <strong>si</strong> morbiditate la acesti pacienti, fi<strong>in</strong>dabsolut necesara combaterea imediata a acestor factori agravanti (6).Exam<strong>in</strong>area CT poate evi<strong>de</strong>ntia leziuni cu po<strong>si</strong>bila sanctiune neurochirurgicala,fi<strong>in</strong>d urmata <strong>de</strong> tratament specific <strong>de</strong> terapie <strong>in</strong>ten<strong>si</strong>va ce are ca scoppr<strong>in</strong>cipal combaterea hiperten<strong>si</strong>unii <strong>in</strong>tracraniene (<strong>in</strong>clu<strong>si</strong>v cu monitorizarea<strong>in</strong>vaziva a pre<strong>si</strong>unii <strong>in</strong>tracraniene).Managementul terapeutic <strong>in</strong> traumatismul craniocerebral are la baza urmatoarelepr<strong>in</strong>cipii (7):• evitarea hipoxiei (PaO 2trebuie t<strong>in</strong>uta peste 60 mmHg). Controlul functieirespiratorii pr<strong>in</strong> <strong>in</strong>tubatie orotraheala <strong>si</strong> ventilatie mecanica seimpune <strong>in</strong> cazul pacientului cu GCS
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