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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• tamponada cardiaca;• hemoragie intratoracica;• embolie gazoasa postraumatica;• hemoragie active intraabdominala.Obiective1. Efectuarea masajului cardiac intern2. Controlul hemoragiei intrapericardice3. Controlul hemoragiei intra<strong>toracice</strong> produse prin lezarea cordului <strong>si</strong> avaselor mari4. Eliminarea aerului embolizat5. Clamparea aortei <strong>de</strong>scen<strong>de</strong>nteResuscitarea volemicaPrincipii generale:1. Resuscitarea volemica <strong>de</strong>pin<strong>de</strong> <strong>de</strong> statusul hemodinamic la prezentare.2. Evaluarea clinca initiala (frecventa cardiaca, pre<strong>si</strong>unea pulsului, pulsulcapilar, statusul mental) ofera informatii asupra cantitatii <strong>de</strong> sangepierduta.3. Se incepe cat mai precoce4. Hipoten<strong>si</strong>une arteriala permi<strong>si</strong>va (TAM = 55-60 mmHg) cand nu existacontraindicatii (trauma inchisa la care nu s-a ga<strong>si</strong>t cauza, traumatismecraniocerebrale <strong>si</strong> medulare, pacienti varstnici cu functie cardiovascularaprecara) (1)343Tabel 4. Estimarea cantitatii <strong>de</strong> sange pierdut (4)stadiul 1 STADIUL 2 StADIUL 3 STADIUL 4Pier<strong>de</strong>re < 750ml 750 - 1500ml 1500-2000ml >2000mlPier<strong>de</strong>re % < 15% 15 – 30% 30 – 40% >40%TA N N scazuta scazutaPuls 140Pres. Puls N scazuta scazuta scazutaFR 14 - 20 20 - 30 30 - 40 >40SNC Usor anxios Mo<strong>de</strong>rat anxios Confuz ComaDiureza/h 30 20 - 30 5 - 15
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