Protocols - Hemorio

TREATMENT – proposition from available cover in Institution: In order to better systematize the
attendance, we establish as switching routine for special covers on a 6-day period, being secondary cover
switch determined by its saturation.
Ointments must be switched in a shorter period (up to 48h),and it must follow the secondary cover
saturation. According to ulcers wounds options are:
- Presence of necrosis: colagenase ointment, debridement with instrumental;
- With phlogistic signals: activated charcoal (if there is exsudate), colagenase ointment, silver
sulfadiazine cream;
- Presence of corruption: colagenase ointment, Unna boot and/or mechanical debridement or with
instrumental;
- Predominance of granulated tissue: Unna boot, colagenase ointment.
Notes:
(1) At perilesiona skin it will be indicated: dexamethasone cream and mineral oil (restoration of epidermal
barrier). After scaring, use mineral oil.
(2) Anti-tetanus vaccination shall be updated.
(3) The difficult cases of outpatient conduction (complication) will be discussed between the room doctor
and the assistant-doctor and/or the Clinical Leader
(4) In refractory cases, consider Hyperbaric Chamber with Switch Transfusion Program.
9. BONE ARTICULATIONS CHANGES:
BONE NECROSIS:
- Clinical Treatment: avoid carrying weight, use local warm and painkillers. In case of head and femur
trauma, it is recommended orthosis to avoid underweight in the affected limb. The chronic use of antiinflammatory
is not indicated.
- Surgical Treatment: to conduct the patient to be evaluated in Orthopedy
- Rehabilitation Outpatient: to conduct all patients to evaluation and follow-up by a Physiatrist.
BONE INFARCT:
Hydration, painkiller and anti-inflammatory (see pain crisis).
10. CARDIOPULMONARY COMPLICATIONS
ACUTE THORACIC SYNDROME
It corresponds to any acute episode associated to thoracic pain, fever, respiratory symptoms, hypoxemia
and/or new infiltrate showed on chest x-ray.
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