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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Tratament:• Toaleta, bandaj ocluziv• Drenaj toracic aspirativ• IOT cu ventilatie mecanica in caz <strong>de</strong> nece<strong>si</strong>tate: PSV• Refacerea chirurgicala a peretelui thoracic3404. Embolia gazoasa (aer) postraumatica (1,2,3)Cauze:• Plagi penetrante <strong>toracice</strong> (mai frecvent)• Contuzia pulmonaraPatogenie:Cauzele <strong>de</strong> mai sus permit comunicarea directa intre <strong>si</strong>stemul venos pulmonar<strong>si</strong> caile aeriene intrapulmonare, astfel incat aerul ajunge la cord <strong>si</strong>ulterior in circulatia <strong>si</strong>stemica; manifestarile clinice se datoreaza patrun<strong>de</strong>riiaerului in circulatia coronariana insotita <strong>de</strong> <strong>de</strong>primarea miocardului <strong>si</strong> incirculatia cerebrala insotita <strong>de</strong> semne neurologice.Factori favorizanti:• Hipovolemie cu sca<strong>de</strong>rea pre<strong>si</strong>unii venoase pulmonare• Pre<strong>si</strong>une crescuta in caile aeriene: ventilatie cu pre<strong>si</strong>une pozitiva, pneumotoraxcompre<strong>si</strong>vScenariu tipic: Pacient cu traumatism penetrant toracic care intra in socsau in stop cardiac dupa IOT <strong>si</strong> ventilatie mecanica cu pre<strong>si</strong>une pozitiva.Clinic:• Soc sau stop cardiac precoce dupa IOT <strong>si</strong> ventilatie cu pre<strong>si</strong>une pozitiva• Hemoptizie• Alterarea statusului neurologic, semne focaleDiagnostic‣ Suspiciune clinica mai ales in cazul scenariului tipic‣ Prezenta bulelor <strong>de</strong> aer la recoltarea sangelui arterialTratament: chirurgical - toracotomie cu clamparea hilului pulmonar <strong>si</strong>apoi masaj cardiac intern viguros.5. Hemotoracele ma<strong>si</strong>vDefinitie: acumularea <strong>de</strong> sange peste 1500ml in cavitatea pleuralaEtiologie: traumatisme <strong>toracice</strong> inchise sau plagi penetrante in parenchimpulmonar, perete toracic, inima sau vase mari.Actualitati in anestezie, terapie inten<strong>si</strong>va <strong>si</strong> medicina <strong>de</strong> urgenta
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