Managementul pacientului cu sincopa in departamentul de urgenta ...
Managementul pacientului cu sincopa in departamentul de urgenta ...
Managementul pacientului cu sincopa in departamentul de urgenta ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
138fuzia, durerile <strong>de</strong> cap, fatigabilitatea, tulburarile comportamentale sau somnolentanu sunt caracteristice s<strong>in</strong>copei. Se evalueaza nervii cranieni, ROT,<strong>de</strong>ficitele senzoriale. Deficitele neurologice severe pot fi corelate <strong>cu</strong> <strong>s<strong>in</strong>copa</strong>vasopresoare.Pacientul trebuie exam<strong>in</strong>at pentru evi<strong>de</strong>ntierea unor marci traumatice.Trauma poate fi cauza s<strong>in</strong>copei <strong>in</strong> TCC, plagi sau fracturi ale extremitatilor.Leziunile <strong>de</strong> muscare a limbii sunt specifice convulsiilor. Nu trebuie sa uitamsa luam <strong>in</strong> consi<strong>de</strong>rare antece<strong>de</strong>ntele <strong>de</strong> TCC <strong>in</strong>sotite <strong>de</strong> pier<strong>de</strong>rea constientei<strong>in</strong> stabilirea etiologiei s<strong>in</strong>copei.Toti pacientii <strong>cu</strong> <strong>s<strong>in</strong>copa</strong> si anemie necesita un test al hemoragiilor o<strong>cu</strong>lted<strong>in</strong> scaun. Intr-un studiu toti pacientii <strong>cu</strong> anemie si <strong>s<strong>in</strong>copa</strong> au avut testulhemoragiilor o<strong>cu</strong>lte pozitiv.Cateva manevre simple efectuate la “marg<strong>in</strong>ea patului” pot fi utile <strong>in</strong>elucidarea episodului <strong>s<strong>in</strong>copa</strong>l:- manevra Hallpike poate fi efectuata la pacientii care <strong>de</strong>scriu un episods<strong>cu</strong>rt <strong>cu</strong> semne prodromale (vertij), pentru diferentierea <strong>de</strong> vertijul posturalparoxistic benign;- modificarile <strong>de</strong> ortostatism marcate <strong>de</strong> o sca<strong>de</strong>re <strong>cu</strong> peste 20 mm Hg aTA sistolice, o sca<strong>de</strong>re a TA diastolice <strong>cu</strong> 10 mm Hg sau o crestere a FC <strong>cu</strong>peste 20 bpm pot <strong>in</strong>dica o hipotensiune posturala. Bradicardia ple<strong>de</strong>azapentru <strong>s<strong>in</strong>copa</strong> vasovagala;- masajul s<strong>in</strong>ocarotidian a fost folosit <strong>cu</strong> succes <strong>in</strong> diagnosti<strong>cu</strong>l s<strong>in</strong>copeid<strong>in</strong> hiperreflectivitatea s<strong>in</strong>ocarotidiana, dar poate provoca pauza s<strong>in</strong>usalaprelungita sau hipotensiune.EtiologieIn tre<strong>cu</strong>t etiologia s<strong>in</strong>copei se baza pe efectele vasovagale, ortostatice,aritmice, situationale etc. In prezent, <strong>in</strong> functie <strong>de</strong> studii si prognostic <strong>s<strong>in</strong>copa</strong>poate fi:- cardiaca- noncardiaca- idiopatica1. S<strong>in</strong>copa cardiaca poate fi cauza unei afectiuni vas<strong>cu</strong>lare, cardiomiopatii,aritmii, disfunctii valvulare; ECG este esential pentru a face diagnosti<strong>cu</strong>ldiferential <strong>in</strong>tre aceste posibile cauze.• sca<strong>de</strong>rea perfuziei asociata cardiomiopatiilor severe, IC, valvulopatiilorpot duce la hipotensiune si implicit la sca<strong>de</strong>rea globala a fluxuluisangv<strong>in</strong> cerebral. Frecvent acesti pacienti au medicatie care reducepostsarc<strong>in</strong>a, contribu<strong>in</strong>d la producerea s<strong>in</strong>copei;Actualitati <strong>in</strong> anestezie, terapie <strong>in</strong>tensiva si medic<strong>in</strong>a <strong>de</strong> <strong>urgenta</strong>
Change language