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 ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
246• un cateter venos periferic <strong>de</strong> calibru mare, comb<strong>in</strong>at cu un <strong>si</strong>stem <strong>de</strong><strong>in</strong>fuzie rapida a flui<strong>de</strong>lor este mai eficient <strong>de</strong>cat doua - trei cateterevenoase periferice <strong>de</strong> calibru mai mic• la pacientii care nu raspund la resuscitarea cu flui<strong>de</strong> se monteaza uncateter venos central, eventual cateter Swan-Ganz• masuri <strong>de</strong> prevenire / corectare a hipotermiei• a<strong>si</strong>gurarea unui stoc a<strong>de</strong>cvat <strong>de</strong> sange <strong>si</strong> produse <strong>de</strong>rivate• toracotomia <strong>de</strong> urgenta se face sub anestezie generala, cu alegerea anestezicelorcu efect <strong>de</strong>primant miocardic m<strong>in</strong>im – ketam<strong>in</strong>a <strong>de</strong> exemplu;la pacientii comato<strong>si</strong> sau <strong>in</strong> <strong>si</strong>tuatii <strong>de</strong> maxima urgenta (pentru masajcardiac <strong>in</strong>tern) <strong>in</strong>terventia poate <strong>in</strong>cepe fara anestezie• <strong>in</strong>tubatia traheala <strong>de</strong> urgenta se face cu sonda cu lumen unic, iar dupastabilizarea pacientului, daca este necesara <strong>in</strong>tubatia selectiva, se poatefolo<strong>si</strong> o sonda cu lumen dublu• se prefera <strong>de</strong>comprimarea spatiului pleural (montarea pleurostomei)<strong>in</strong>a<strong>in</strong>te <strong>de</strong> <strong>in</strong>itierea ventilatiei mecanice• se prefera <strong>de</strong>comprimarea sacului pericardic <strong>in</strong> caz <strong>de</strong> tamponada cardiaca<strong>in</strong>a<strong>in</strong>te <strong>de</strong> lar<strong>in</strong>goscopie <strong>si</strong> IOT• evitarea premedicatiei la pacientii <strong>in</strong>stabili hemod<strong>in</strong>amic• pregatirea unor meto<strong>de</strong> alternative <strong>de</strong> a<strong>si</strong>gurare a cailor aeriene, <strong>in</strong> cazulesecului <strong>in</strong>tubatiei oro-traheale (cricotiroidotomie <strong>de</strong> urgenta, ventilatiape ac etc.)• se ia <strong>in</strong> con<strong>si</strong><strong>de</strong>rare oportunitatea <strong>in</strong>tubatiei traheale selective (leziunibron<strong>si</strong>ce <strong>si</strong> pulmonare contralaterale)• aplicarea secventei rapi<strong>de</strong> <strong>de</strong> <strong>in</strong>ductie, pentru a preveni regurgitarea <strong>si</strong>aspirarea cont<strong>in</strong>utului gastric• utilizarea dozelor m<strong>in</strong>ime eficiente <strong>de</strong> droguri anestezice• asocierile medicamentoase folo<strong>si</strong>te sunt mai put<strong>in</strong> importante, primandment<strong>in</strong>erea stabilitatii functiilor vitale• necesarul <strong>de</strong> analgetice este crescut, iar elim<strong>in</strong>area acestora este scazuta, cupo<strong>si</strong>bile efecte hemod<strong>in</strong>amice, respiratorii <strong>si</strong> neurologice mai accentuate• se prefera opioi<strong>de</strong> <strong>si</strong> benzodiazep<strong>in</strong>e cu timp <strong>de</strong> <strong>in</strong>jumatatire scurt, pentruo mai buna titrare a efectului• este contra<strong>in</strong>dicata folo<strong>si</strong>rea NO 2ca agent anestezic (ventilatie mecanicacu oxigen 100%)• la sfar<strong>si</strong>tul <strong>in</strong>terventiei chirurgicale, pacientul este transportat <strong>in</strong> sectia<strong>de</strong> terapie <strong>in</strong>ten<strong>si</strong>va/salon postoperator; pe perioada transportului acestatrebuie monitorizat cont<strong>in</strong>uu <strong>in</strong> prezenta medicului anestezist• evitarea, daca este po<strong>si</strong>bil, la pacientii cu contuzie miocardica, a anestezieigenerale <strong>in</strong> primele 30 <strong>de</strong> zile posttraumaticActualitati <strong>in</strong> anestezie, terapie <strong>in</strong>ten<strong>si</strong>va <strong>si</strong> medic<strong>in</strong>a <strong>de</strong> urgenta
Change language