Managementul pacientului cu sincopa in departamentul de urgenta ...
Managementul pacientului cu sincopa in departamentul de urgenta ...
Managementul pacientului cu sincopa in departamentul de urgenta ...
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144radrenal<strong>in</strong>ei ment<strong>in</strong>e presiunea sangv<strong>in</strong>a la valori constante. Un rezultatpozitiv apare cand nivelul noradrenal<strong>in</strong>ei sca<strong>de</strong> <strong>in</strong> timp, iar presiunesangv<strong>in</strong>a si frecventa cardiaca produc simptome (raspuns vaso<strong>de</strong>pressor– hipotensiune, raspuns cardio<strong>in</strong>hibitor – bradicardie). Acest test estemai put<strong>in</strong> specific <strong>de</strong>cat testele <strong>de</strong> efort/electrofiziologice. Un test negativnu exclu<strong>de</strong> <strong>s<strong>in</strong>copa</strong> neurologica.• EEG – poate fi <strong>in</strong>dicata <strong>de</strong> neurolog pentru un diagnostic diferential <strong>cu</strong>un episod convulsiv.• Testele <strong>de</strong> stres/studii electrofiziologice – sunt mai specifice <strong>de</strong>catmonitorizarea Holter si ar trebui efectuate la toti pacientii <strong>cu</strong> aritmiesuspectata a fi cauza s<strong>in</strong>copei. Un test <strong>de</strong> stres cardiac (efort) este <strong>in</strong>dicatpacientilor suspectati <strong>de</strong> <strong>s<strong>in</strong>copa</strong> cardiaca si care au factori <strong>de</strong> riscpentru ateroscleroza coronariana. Acest test poate fi util <strong>in</strong> stratificarearis<strong>cu</strong>lui si pentru stabilirea unui ghid terapeutic ulterior.Manevre• Masajul s<strong>in</strong>ocarotidian este utilizat <strong>cu</strong> succes pentru diagnosti<strong>cu</strong>l s<strong>in</strong>copei<strong>de</strong> s<strong>in</strong>us carotidian. Pacientii sunt monitorizati cardiac: TA, FC.Atrop<strong>in</strong>a se t<strong>in</strong>e la <strong>in</strong><strong>de</strong>mana (“la marg<strong>in</strong>ea patului”). Masajul se efectueazatimp <strong>de</strong> 5 se<strong>cu</strong>n<strong>de</strong> <strong>in</strong> regiunea <strong>in</strong> care se palpeaza pulsul artereicaroti<strong>de</strong> la nivelul cartilajului tirodian, pe rand, <strong>de</strong> fiecare parte. Efectulmaxim se obt<strong>in</strong>e dupa aproximativ 18 se<strong>cu</strong>n<strong>de</strong>. Se consi<strong>de</strong>ra rezultatulca fi<strong>in</strong>d pozitiv daca se obt<strong>in</strong>e asistola peste 3 se<strong>cu</strong>n<strong>de</strong> sau <strong>s<strong>in</strong>copa</strong>. Dacatestul este negativ procedura se repeta <strong>de</strong> partea contralaterala. !!! Pru<strong>de</strong>ntala pacientii <strong>cu</strong> afectiuni carotidiene preexistente (ateroscleroza)la care teoretic masajul carotidian poate precipita un acci<strong>de</strong>ntembolic.Tratament<strong>Managementul</strong> s<strong>in</strong>copei <strong>in</strong> prespital <strong>cu</strong>pr<strong>in</strong><strong>de</strong> un spectru larg <strong>de</strong> manevre<strong>in</strong>cluzand evaluarea rapida a cailor aeriene superioare, respiratiei, cir<strong>cu</strong>latiei,statusului neurologic.1. Tratamentul <strong>in</strong> prespital <strong>in</strong>clu<strong>de</strong>:- acces <strong>in</strong>travenos- adm<strong>in</strong>istrare <strong>de</strong> oxigen- tehnici avansate <strong>de</strong> ment<strong>in</strong>ere a libertatii cailor aeriene superioare- adm<strong>in</strong>istrarea <strong>de</strong> glucoza- suport cir<strong>cu</strong>lator medicamentos- <strong>de</strong>fibrilare sau pac<strong>in</strong>g temporarActualitati <strong>in</strong> anestezie, terapie <strong>in</strong>tensiva si medic<strong>in</strong>a <strong>de</strong> <strong>urgenta</strong>
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