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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226pla ridicare <strong>si</strong> <strong>de</strong>plasarea anterioara a mandibulei corecteaza pozitia limbii<strong>si</strong> poate <strong>de</strong>zobstrua caile aeriene. Pacientii cu reflex <strong>de</strong> <strong>de</strong>glutitie prezent i<strong>si</strong>pot ment<strong>in</strong>e <strong>si</strong>nguri permeabilitatea cailor aeriene. Introducerea unei pipeGue<strong>de</strong>l la acestia poate <strong>de</strong>clansa varsatura, mobilizarea coloanei cervicalesau cresterea pre<strong>si</strong>unii <strong>in</strong>tracraniene, fi<strong>in</strong>d preferata utilizarea unei pipe nazofar<strong>in</strong>giene.<strong>Pacientul</strong> aflat <strong>in</strong> apnee trebuie <strong>in</strong>tubat <strong>de</strong> urgenta <strong>si</strong> ventilat mecanic.Ventilatia pe masca poate duce la disten<strong>si</strong>e gastrica, risc <strong>de</strong> varsatura cuaspiratie pulmonara secundara. Se recomanda <strong>in</strong>tubatia orotraheala cument<strong>in</strong>erea <strong>in</strong> ax a coloanei cervicale. Se utilizeaza secventa <strong>de</strong> <strong>in</strong>ductierapida pentru a obt<strong>in</strong>e conditii optime <strong>de</strong> <strong>in</strong>tubatie ale pacientului. Dacamanevra <strong>de</strong> <strong>in</strong>tubatie esueaza <strong>de</strong> doua ori <strong>de</strong> catre medicul cu cea mai mareexperienta a echipei <strong>si</strong> daca <strong>si</strong> celelalte manevre <strong>de</strong> a<strong>si</strong>gurare a<strong>de</strong>cvata a caiiaeriene nu reusesc, atunci se impune realizarea unei cai aeriene chirurgicale.Temporar, ca manevra <strong>de</strong> urgenta se poate practica cricotiroidotomie cuajutorul unui ac cu diametru mare <strong>si</strong> pe care se adm<strong>in</strong>istreaza un <strong>de</strong>bit mare<strong>de</strong> oxigen. Aceasta trebuie urmata <strong>de</strong> traheotomie, fi<strong>in</strong>d metoda cea maia<strong>de</strong>cvata <strong>de</strong> ventilatie artificiala a pacientului <strong>in</strong> aceasta <strong>si</strong>tuatie.Dupa ce caile aeriene au fost eliberate <strong>si</strong> a<strong>si</strong>gurate, se adm<strong>in</strong>istreaza oxigen100% cu un m<strong>in</strong>ut-volum <strong>de</strong> aproximativ 15 l/m<strong>in</strong>. In cont<strong>in</strong>uare seexam<strong>in</strong>eaza regiunea cervicala pentru evi<strong>de</strong>ntierea <strong>de</strong> plagi, pozitia traheei,disten<strong>si</strong>e venoasa, emfizem subcutanat etc.B (Breath<strong>in</strong>g) – evaluarea respiratieiEvaluarea respiratiei urmareste prezenta/absenta miscarilor respiratorii,frecventa <strong>si</strong> eficienta respiratiei pr<strong>in</strong> observarea culorii tegumentelor (cianoza)<strong>si</strong> eventual valoarea SpO 2pr<strong>in</strong> pulsoximetrie. De asemenea, trebuieapreciat efortul respirator, <strong>si</strong>metria cu care se <strong>de</strong>st<strong>in</strong><strong>de</strong> toracele <strong>si</strong> se auscultabilateral murmurul vezicular pentru a i<strong>de</strong>ntifica precoce leziunile toracice.Inca d<strong>in</strong> aceasta etapa trebuie i<strong>de</strong>ntificate <strong>si</strong> rapid corectate leziunile toraciceamen<strong>in</strong>tatoare <strong>de</strong> viata:• pneumotoraxul compre<strong>si</strong>v• pneumotoraxul <strong>de</strong>schis• hemotoraxul ma<strong>si</strong>v• voletul costal• tamponada cardiaca (vezi punctul C)Pneumotoraxul compre<strong>si</strong>v se caracterizeaza pr<strong>in</strong> aparitia unei <strong>in</strong>suficienterespiratorii acute cu dispnee severa, cianoza, alterarea statusului mentalcu hiper<strong>in</strong>flatia hemitoracelui implicat, timpanism, murmur vezicular multdim<strong>in</strong>uat. Atitud<strong>in</strong>ea imediata, chiar <strong>in</strong>a<strong>in</strong>te <strong>de</strong> a astepta confirmarea radi-Actualitati <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
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