Traumatisme toracice rapid letale - Cursul National de Ghiduri si ...
Traumatisme toracice rapid letale - Cursul National de Ghiduri si ...
Traumatisme toracice rapid letale - Cursul National de Ghiduri si ...
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340<br />
Tratament:<br />
• Toaleta, bandaj ocluziv<br />
• Drenaj toracic aspirativ<br />
• IOT cu ventilatie mecanica in caz <strong>de</strong> nece<strong>si</strong>tate: PSV<br />
• Refacerea chirurgicala a peretelui thoracic<br />
4. Embolia gazoasa (aer) postraumatica (1,2,3)<br />
Cauze:<br />
• Plagi penetrante <strong>toracice</strong> (mai frecvent)<br />
• Contuzia pulmonara<br />
Patogenie:<br />
Cauzele <strong>de</strong> mai sus permit comunicarea directa intre <strong>si</strong>stemul venos pulmonar<br />
<strong>si</strong> caile aeriene intrapulmonare, astfel incat aerul ajunge la cord <strong>si</strong><br />
ulterior in circulatia <strong>si</strong>stemica; manifestarile clinice se datoreaza patrun<strong>de</strong>rii<br />
aerului in circulatia coronariana insotita <strong>de</strong> <strong>de</strong>primarea miocardului <strong>si</strong> in<br />
circulatia cerebrala insotita <strong>de</strong> semne neurologice.<br />
Factori favorizanti:<br />
• Hipovolemie cu sca<strong>de</strong>rea pre<strong>si</strong>unii venoase pulmonare<br />
• Pre<strong>si</strong>une crescuta in caile aeriene: ventilatie cu pre<strong>si</strong>une pozitiva, pneumotorax<br />
compre<strong>si</strong>v<br />
Scenariu tipic: Pacient cu traumatism penetrant toracic care intra in soc<br />
sau in stop cardiac dupa IOT <strong>si</strong> ventilatie mecanica cu pre<strong>si</strong>une pozitiva.<br />
Clinic:<br />
• Soc sau stop cardiac precoce dupa IOT <strong>si</strong> ventilatie cu pre<strong>si</strong>une pozitiva<br />
• Hemoptizie<br />
• Alterarea statusului neurologic, semne focale<br />
Diagnostic<br />
Suspiciune clinica mai ales in cazul scenariului tipic<br />
Prezenta bulelor <strong>de</strong> aer la recoltarea sangelui arterial<br />
Tratament: chirurgical - toracotomie cu clamparea hilului pulmonar <strong>si</strong><br />
apoi masaj cardiac intern viguros.<br />
5. Hemotoracele ma<strong>si</strong>v<br />
Definitie: acumularea <strong>de</strong> sange peste 1500ml in cavitatea pleurala<br />
Etiologie: traumatisme <strong>toracice</strong> inchise sau plagi penetrante in parenchim<br />
pulmonar, perete toracic, inima sau vase mari.<br />
Actualitati in anestezie, terapie inten<strong>si</strong>va <strong>si</strong> medicina <strong>de</strong> urgenta
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