illtor metale, snb formi, de pulberi care se suptn unol lrocealee

i.emlnitoale lxbfl.drii nraiclialclor ,.or.tmirc piM ,c :c oblin"

rrn corp compc.l rr drD", l.lt propriellti tlc semi.ojldo.tor.

lsto cEnosctt fa.Itrl ci lezisteDra rnetalelor se noditici in
r,lort crl r.idicarca lempe]atu i lor'. F.r!{ de aceasta, rezisterllr

t,

mistoorclor la temD.rnturi Dra,i

'ltf6.lifi.irile

rrr&Ito cnto mai

ni.;

{t(J rozistrntr, rle tertrristoficlor

I! a.rrir[irle de tcrLrfpr.!tur[ srnt
rrrt1lt ]I i mari
5la mptr.lpior{Lc uxdr rozultx'l..rt
.d, tcrorom etre.le cri
i,,rmiFi,,rirc "{Dt fuafic sellsibilc.DuI rrnl ir[r!ist].
!i r..riatii de 1,tri0 .
'l'ermornetrelo cu tcrmistoa.rc
rrlilira,tc in mcalicini ril1t asemini
1{)ir,lr cu termoxletrele cu rezislcrrii. TermistoruI e"qte eup'iD"s 1*
(,xl,renli1,atea unui tu} ate sticli itr

xrl,ella apa.ratului leg,lti Ae siste

rllul alc conexiune al apaHtului
I'ropriu-zi8, aylnd ca itrtLicator urr
lrieroalrpcrmehu. },e scara ace,ci uir,, sc pot citi in ltloal dir.ect r*lo,
i ilo l,errpelatrrrii mdsurate.
(h aceste aparate, alurfttil
I rf r'llrornclriziririi sc realuco L1 cii:ea-r,
z(rii rlo sccuDale. Alarite.le eristr\tllr iu circrr]atie au scari lctiyi,
irltrc -.)l si ,14' Ei se inuiesc (.rr
li'rr'1(. rrart ufuf ilrlit.
'lt ll)islior.ul ])ropliu zis poate
Ii c[Irjrrs li in ace cu rrn (.slibm a9- lrr. Sct.ma termoDtrutui etec,
- tric o rezistntii.
I'iru'l h l),75 D)m, care inlroatusc in
(tiL{n,ilol\ l}r'ir.ti llc or.ga.nismului
Ir)1, (ln r(,14ii :r\npra tempemturii cerft e sau erentual asupra
l(rnl}(rrlrrrii lurn0rilor.
. .lli,ur:,r'.:r i,.rnt,or.rtruii corpor.rle lo bolnasi sc ii..n obirDuit
rl,. rl.'rri i,rr In. 2,. dirniDcc{a !ci dupi mxs5. 'Natur:r rru g1.a\iraror,
Ir'lii..il :i lrrri,r,r.rtrul d,plicar,
tcmllarr,tura 6ul0arului
'erodcc,cxemphl
s'i tx' llrilNIt ri i.r intorralc )rarlot
nrx.i,
rlio 2 in 2 ore,
rr x'lut,ii :rdIl tLi.:r rrr.r,r onltrnil or rxedii.amcnte eLc.
233

llt.,,1 ., ,rrl,rtil,.:i ,^.ii:rliil,.de l(),rlt,lirrrtrd irr,'ur.ul

uD.'i

zil,.. L rrl,or.,ru11. t-,uare ii r,'n",,mli..i dir | :'irr I : dc ur:. Irl,,.Fi,

cxzuri insil cste l)irre sI fie iolosit nlr ter otrxlr.LL eletl c iffegistrator
l)r'crizri r,ll l)uDctogtf.
Tcnpexilluu rnirsurnti lix.i iluegislr'ilor auton:Lt se nolciizi,
in loai:r, de temlernll1II * boln:rvulni. I'e al)cis:r, riistemnlui ale coordo[t1o tic )teazi lirnpul, i*r pc ordo&l,Ur, grxdul fernleratuii. ],4,
locrl dc r'tltihire rr tiluLgirilor 1r:Lic diII ,rbeirir fi ordooatd, sc liaeazi
cu un pllnct grndul de temperal.luir, lrL nrncnlul lespectit. llrird
prrrctelc m[sirrrte 1a iEtcr'!'tle fixe tte lirlllr crl o linie, oblinen o
itiaq..,ll,.,
r' lrpzinli ourl,:! .r,,lulrfl ri rrl,"rzrulir bol'atulrr-i.
[nlrrr.il
,t.,urrilr ""r.
:i 'lr.,crinr.i Ierork:i s:ttr ',lrll,ri ,l',' r.rrrfe)'clur:1.
rcrrip.rarrrlir
noIrrr.'1.'
srrl"ri,'iLrr:
lorir,lc
lc'Il,tsrrlurir
lir',iln
1,c
{rstc narcalii cu o linie nt*i Sl)asir. (lirrlr-t, sin$u[ }lri\'irc ronr
l)rter ei1; de I)cja.foaie drci bohN\ trl cstr ir hipertcrrnic, ?r'cflr]lr
rii g'-:rC.ui iceste
HiI0rtr'r'mia. for'hirr desIrl-c I'il'orl,rInie df,ci tempcm(urr
cprodu.rlr\ lrr. ., ridicJpeJerX. Il,Lsed:!lorclz;i. Ii, rrLAi rre$teri
rii d..il,Iuln, lie uuei se:l'lori r I'i,r1l, r;lur d..Jldu-rd. ('arrzcl' ''rr"
duc h a,Iarilia hipertr iei dcdrurilit n)odificiri in metalolismul
org5nisnr_ului; din nare motiy hipcrtchrir ertc (le oliceij]lso$iiii-dc
ceialce, d,ursii in lpa.te ai in e\treDit:iii, :1ccelerarea. puleuLr.i-+LL
f!spi!-ali9i, congestja Jcleijq&petent?i, sote, linilr, Iscat5, oligllic
niniiorccnirate Si o stare gcnefilii rrltcl.,l.ti,, t{lbElali nerroaie
irr
','alc Ioir., ,1r.:1 iD riDelc
lazuiil'i,,,, lir rrrll,ur:'ri-de c(!!oirtut.'iJi
tlelir. Totciir'.re', xcFstoI iinrplol're tt,r'l,:rzti 'ioilrornu] iPlril Tn
l,rrcrinr crrr,n-l ,nsa, leI' cnul fcb''il !,'i"'r'J"nda.u"tia;li d.e hiper'letnlie.
DuIIi gr'rdlll dc hipelterllric rllr'isnl,:riir iD flxili, r'eacl,io febrili,
!. Jmt'Jt'ts in rrr'LrA1o:uele .alcFolil:
Temlcl.aturir, Dorma.l5. 36 3?" '-

T.rnl,.rrlrri .ubfeblil:i :li 3\ .

IreLli nrfller'ati 38 3C" nebri lidicati 30 11" Hiler?ircnio !11 {:'c1'entuil r.i tn:Ii l)rult.
lreb]'i, ?Iczinti in mod ol)ifmrit ncd, rrrri oscilalii zilnice (1a,li
j.,a.rl. .io,l rorbjm_d.
r,.n.l,, r'rlrrri t,oflr ili. Llirtrtro:rl:!
',.1. r,rrrr

rorr is,r n+rirr:rla.i:.;s..rr:r."l.r,r:riridicrli.'rr,l \o,t,i'ndepxarerba'

)cll rcslcralii.
Telr)relatura cca mai jorsii, [rri.$rmti in cl1rs de 24 alc orc'
s0 mcslic temlelatu}a Dirimi, ial tcnrilelttrm cea mai rialicati,
touperntnlr'i narimi.

:81

iD eyolttia oricilei lebre se pot. distinge trei pedoaale : Icrioaala

inilialE, perioada de stare qi pefioaaln ale aleclin. Durat:L ti c1'ol[1ia
perjoaalelor pot ii bine stualiate pe loile de tem?eraturi, (fig. 1,t1).
). fptioaila inilioln s t de inya.zie a Lbroi. -Febrx purip rlr.r
brusc, in decurs ale citeri or, tenrper'attra ajungind pin5, la ltg 10',
ca de exemplu iD pneurronic. --Icnrr-lu1a,rea, imemi, ale oilaluri este
larorizati, !e de o pa[e, de scialerea piextlerilor de cildui pr.intr. o
\-asoconstriclie pedterici ptrtemictr, lnsotitd de senzatia ale frig,
iJr pe de all A lartc, de ooh'a.' Liile nrnscnli,ro sub lormd d. r remurr Ir,r i. rnanjlcrrale prin ' fuisourd dc debol,.
ID al{a crzuri, debulul fobrci poalo fi lenl, lenpcrctum ut'.i0d
progresiv din zi i\l zi it i sus s1lb iol'ntll, unor oscilatii asce[dentc,
ca de eaemplu ln {ebra tifoiill.
2, Peri.oad,a il,e sta ]dnreozi de la citeya orc !iu.[ la citeya si?timjni. inarpasi, per ioadii, lebra atiogp putrctnl ci(ulmiDanl. Caoiirarca alc c;ldur; Eeccsari peELru slarea de bilrFl1errric lu accd-tn
perioaali este fulrdzatd, ln primul riral de fici.t, pe searna proceselor
eDergetice determinate ale ar'alerea ghciile.lor $i gTisimilor, pentru
Ca alupi ep$zarea arestora si se atace Ei atepozitele ale proteine.
DuIS o.pilaljile zilnicc : e lcmperalurii $i dupe erolrLlie deosebiro
in aceast5 perioaalS tuferite tipuri de febd,:
dl .rlbl"Lrililate rigidd, ix fieraslrS,o.'Iemperslru, Eu depaso$rp
37".4 iar obcilaliile din .trrsul zilei sint abiado 0,t 0,2". A.cabii
Jebri este ale obicei neinlectioasi, de Datud, umora,ld, sau vegetatiy5 ;
,) Bubletrilitatm cu oscilatii,,fiziologice', (fig. 142) ; temperatuo
ajtnge pini,la 37,6 3f"!8 iar oscilatiile stnt de0,4 0,5". Se tntllrette
in inlecliile de locar gi in tuberenloza prlmotrard iucipienti;
l1) febra, col1tinui (tig. 143); bolnaruf este tot timpul febril,
dar oscilaliile alinti:e teDpelatua de dimitreati Si cea ale seara nu
depilesc 1". Acealt; crlrbi, o futiluir[ in pneumonie, lebri t oidi,

tifos exaDtenaf.io etc. ;

d) febm remitenti (Iig.

1{l); oscilatiile alr4tre tenlpemt1lla do

dimineale, $i cea ale scarr depi,scsc 1", dar tempeIaturr, se menljne
tot timlul deaBulra r.alorii normflle. Se ini.iltreite i[ selticenii,
.upur'rlii. r uLer,'ulozn pulmoDill; glari- uDele lor'nie rle br'or,Lopr,nurnonii etc.;
) tebuu iDtelnitenG (fig- 1l;); ililexeDta dintre tenper,atura
il, drn'ineila ri { ea ,le sea.ri esle dal'it-era qradc, tem 0.t a lltrr mi0 im,
ltiDgi[d valori]e nonnalc- Ternperatur.] se fialie5 brusc aub formi
dc accei penlr'u citeya ore alupi, citre scaalo Brb 37'. Aceasti Iebri,
o itltil m ln scpticemii gi anunrite lorme ale tuberculozi pulmonari i
/) te}ra intermite[td, pelioalici a.rc caracterele febrei intermiljeEte, dal aecesele se tepetd,la acela.i inten'al ale timp, putinil Ii ss?ara'te
285

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-s

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e

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:lfl6

c
,t

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i
"
988

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ir
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t

r
t'
s
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I

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290

it

F
s

si als zile alebrile. Aceastd febni o itrlilnim itr naz de rnalal ic. Acceselo

Ii zilnice (Iebra col,idiar6), la doud ztle (febra terld/ {tig. 146)

sau Ia, trei zile (febr'a cYarti);
,r lebra hctic6 Drezill,i o curbi asomiDdloale cu .er a Iebrei
;otniinitente. dar cu ;scilatii zilniee de 3- i", cu scaderi bru$tP prnir
lr lemppratiua subDormald. Se irt tro:lc in seplicomii $i .torlncle
lrrr,vo dle tuberculozd DulmoDari, i
'' irl lcbra lecurentd (fiq. 1.4?): perioadele febrile de'l-d zile cLr
lmDeriturd conliDud all,=emait co perioade afebrilg tle aceea$i
,tul;rr. Aoeasli curbd, se intiloeql,e itl Iebrr |e.ureati, prerum ?i
in unclc forme a1c limlogranulomatozei maligne; u
i, Iobra oDdulaotrf,, (fls, 148)i Pexioadelc lebrile xllorneazi
'
perioada
la
i
recera
de
r)orio;de atcbrileca,!i febia lb tip recurent,tostr
ifolrr'ili la cea tebriid, tru se fBce bruso, ci tteptal prio os(ihlii asoeodonto desce[dsDte' dl-trd curbei fpbriio cam'clerul unei litrii oD'lul'nta- so'lilntllneste ln brucelozd:
it Isbra ho ti! inver8 i iemperatura nrininra so lffegistroazl
n"a-r'i. i*r t e-po""tioa mexihll diinincat4. Accasltr febri oslo carac_
r orjsticd lrcEtiu lubcrcrdoza pdmonartr $41_i ;
aaceDsiunils gi Eciderile do tempe}atuH
A) fdbra neregulal,6:'lD
aceal, caz vorbim do febra treregulatd
,,u odt
fi
sistomat"irate.
-8.
?erioad,' da d,di& sau stadiul de deflvscoBtu, asemtrntrloarc
(tclrutului. Doate fi brusc[ 8au criticl {i letrt5, progresiYd 8au litic,.
lu caz <le t-srmiuare brusctr & febrei, temporatura scade lE citeYlt
ulo la trorEral 8atr chior sub normal. Paralel 8o ametrdeazd ln mod
r'clativ brusc Fi celelalte SimDlomo ale sitrtlronlului foblil' totul terminixdu-se ou tr'anslira.tii abuidcntc $i Doliurio (ds tlemplu pDoumonie
ri' tifos 6xeniematic),
I'ebla Doato sI'6e terDJne Ei lent rgresiv ciDil temlelotura
rcarle lncot in mai multo zilo Plin oxcilalii de-Bcondeale ca do oxomllu
lll Joha tifoid.6 sau scarlatini.
IliDolormi0. vorbim dc hipot,elnric atunci cind lenrperofrua
urca!iBirrului scade sub 36". Stdiea dc bipotetnrie ealc dolsrlninald
lie- ate o pieralere excesive ilo cllatnlii (ca ale xomplu 14, pel'soano
,.rpuse friguJrri pul erDic),'fie do srldclc^proorlollrlE a metrbolisnrului si dimiDual.ea arderilor din orga.trisrrr $i deri 1l pro.lu'tlor (16 caldnl1,l
Iir'do exemplu iD inBDitie, Iulbilrfui etdodilrc, iu.rlficieDl5 'iIcDl'
I urje, atecliilni ccraliopillmolxrrc, corn6 Iepal icji' Pieraleri ul,\irc

irot

,lesioge,a;crriilnaiDtr.-tecl(.),tiedcoitrter-sontier!i.itnruluioel'eog
(eEtra].

Slarile ale Lipotermie arr luel o ilrrporlanla aleosebila in ullim-ii

aDi prin itli rodurirea itr clinice a hibemolorapici. Prin acea-sl e mtoal{'
so di(oDectpaz,, pe crle medicir nlpal oxs}, centrii Dplvoli ile lermors_
291

t
N

Ig
-!

l|9il

\
N

i
293

\
N

a
E

glarp, penlru c lulP, ridtlco LpmlclalurS sub \.llolilo Dormale'

iaii-",i-"" oor,ireic rczanicle orqani.mului prin procesul normrl
'le
Ten,poralura poaleli redubi mult sub valorile llormalp
^ri.r.iia*l
snaderea m"tibolismului, scado qi aevoia ile oxigeo a
"i ^-""ii"i. ""i" (tezi capilolul
cu subslaD'
or'ganismulni
',lDgr'ijirar bolna!ilor trafa(i

te nerroplegicir").

ln cursul tralarn"nr LIui, priD hibornare ar'tiIicia]i' lempelatu-ra

ormDismului Doa le fi rcdu", la 26 -32'. So laC inter! cq ii chlrurgcale
t.i""-",rura
nor'arrtir de 27 28". cjnd T'pri.oluI bomorogiei .e r'dtrce mull
iiin
tnc"'inirii proc.solor'1ilale. Areslc .l5ri de Ijpolermic
unor metode noi de m5luraro lemperaturii,
,ii,

^
""."ii"ilrirr"Or*r'ea
mai sus.
adtato
tnrepiptrarea cotiliincjo$se a lempelatur'ii bolmsului poale
tA fulim;ine greulali iD uazul simulcBlilor' Dari se na${e bdnurcLa'
ca lobra ifl esfu ril n ar {i irealb, de tra1 urA .,1'lmomel rrca',1 ermomeirizarea boln;sului .o \a fafe Dumai sub supra\eghelc ctuccla.bo
tp'mittr caro de .oDlcel
ia analiza apoi in mod an;Dualil curba
a
bolnaflrlul
geDerali
.farec
$l rucl cu tlipluue
nu va eorpslunile cu
obiqnuire dd felra. IIai deparro 8e ra m5sura lpmpelatura ru mar
sau 10 plus !i
;ii" i;;;;;ir;. de exeirplu in cele doua arile
rdu iDten(ioaati'
r{ic
'n
cnlilor
sim
i'ebra
i""i'"i ri, .ril6i;i oucali.
fie n;lrotici) tru ra ala nirioclal, da{e conclu'l'oie la masuratort
imedia't dupi aftmarea
il-uftu"". C'o"utrtur"a stirii de alebrilitato pertru
simrlaxea febrci'
pledcazd
sjgur
;ff;i f";"ll; d;;;ilbolaav
aLuzivc de aDti_
offu$il
uma
aallr'inis{rAlii
ca, ln
trlntioDitm. ir
5 c diag0osl icue:arI
abilrea
ini
e
de
bl
e
l;a
rrioLi"" S'niG i"iJi"umcnl
jnlerprelarea
clrsicp.
i"i"." i"i"i.*ra dp mulrc ori curbelo febtilp
rl,ial
inrpo$ibili.
lor de\eDind foar'le grra s.rlL
r

PULSUL

Cu ocazia sisrolei reDlriculrre, siDgelo esle lnliDs din caeitltile

raniricuure in artercle marj. Acaabl[ mosi ale singe i!{iule$I0 lo
riil"r',iJ".+"ri"L rlte maBd d. sbrge do r,t'c se tove!-te bub.inJluenta
" a mu$chiului cardiac. Coollictul care ja nc$1ere
(onkacliei !ulFrnj.o
i,iif iii" olrii ooiume oe'stnge se propag' priD coloana san$rind

rlin arborele arr orja t oub lormn unei u nde Yibralorji $i se extotiorrzoazi l)rio degiiDderpa ritmice a xrterelor, siucroD-5 cD SiSlolele rol1ln_
,'ulare.
Aceasti, destindele dlmicd poalP fi palpatd ('pdElnd Llfor ar'terel
pe 6upraf61e dure osoase) rub forma uDol zvl'niluri uEoare, rltmlce,
Inlsatile, de ullale Dumele do Puls.
255

1,, rr",;,;, l, lsulni iotcrr jll. : i, iDirn:,. crr ..i v.rn.j,..

rellH tJ. aril slrr.x ftru,.lioD.ltri a inir,,i,., rr ,;; 1. c..sr, r,.r,.i,,,.
,lin,l in a.el".i , iruI, iDd i,.ii plclioase asrl,r:r ,r,, r'ii i nr ro,rric" "r,r ,, r r,,,,.

.I

\i

lnrrrr.it

Lri itrterirl.
Lr I'otile i, fp,.lioaro ,rut,., I'ulsul ostin,lo..t,. ari\ i :,r(i ilrtc.ri,.i
II'ognn,lii.ul deliD'lc in .,'.p.to caz r i iir
r .
.. , i de trlirar;i,.
pulsului. ItodiJi.i lo ,,,rncrorlrhri I,ut.utIi ,t,.r,.rr, ni
^i ",,";i";r,
l.rapcuriri iD rclo Irii Drult.c,czuri. Dio rr,,.t r,r,rir. e\.rnri0ul.,".
|,rISriror.li Dor.rreJ I,IlF lIi xrr ,, rl.os.trir:.
I
, 1.orrr,,i
i[grijirea bolnavilor.
tttLtsuldi. Plllsul loat,.fi lrrat In.,,r,,.,r,.i t.I:,:,,,,.:iLit
. L o r.arI
pelpi(ror.
J,orl.Ii corn!riDr:rti p. llIl trIlh,.{,. : llIli:,1]. ttxroor.r_
r

r ,. ,

r i r.,

r r

r .,

li

sulodiciall. r rrol irla, humerrli, fpnrrtrali, trrli,r:r.,rr ,.tc. trL or..ir ic.,
!ul. l ..p in la nisolIl art,.loi rxilirlc.lir ,..,r. r,;r,, ,.
limbaj colidia u. l,rin p ls sc in!etpge IrrJb l :rrt,,r,.i .,r,ti,,f,. rfic. t rt,.
Lr Iuarer prrl.rilti. boln:rrul Irnl,Iio nx ti,. irr r.rr.r,t. lr.,ic .i
psIIrc fel t'uliu;. I0 miou{,c irl.riote rto nrI|IiriLoar,,: rnl,I(rL Lr;
clol l .cu o ox,,,liF orle4r.rc. in I.irnl,rrl .:rI rn,liltc,r l,lrirri
t,,rl. lIr.
trl putea modilicll \'&lorile rea,le. Braful l)uln.rr.ului t|ebujc
si lir
bprijinil,pc0lru'arnugr.Liuta.otobr.r(lltiri Jti,rrolir,.zr. S. *"";",,;.,
iaD(ul mdiui (,lcnrI|Uit $i $rn(.r pulsutlli) t'o.\rroll,itxtcx d:"r.,t;
rnlebraluluj, m I onlioualo:r policelui. lI :ri,rut,i,.rcll 1!rrlrinii o\tr,,,.
Ietej anler ioilr-. i nnloLratdui rlinr rtl i.r,.,,r1 r,.,irgii,ir ,t. i. ,.
1
dor_nelo nru?c}il"t ik\ot radial al rnn, lIi .i tr.rlri,,r:,,1i:,1fl1. r.l
frul0Dzrm.l .;rui sc gispite .ul,cra rr,lr:rl:r.
pul.ul i sl, t,!(:c r[ \irlxl r1,.,r,.'..1,,r i ,t, \. ,,,.rt]i, .i
.iu,lir
I T':rlp0r'Fr
dr Ix r,rinc rbmpti. t)npi co i L r,.tx.r.:rr ..,r,{,rt t,ri,... \.,
Hr.r,ir,, o rri,,,,ra pr.si oc l},\upr:r t'or.et,.lrrr ,,r.r,.r:;:,t r,"lrir.,len,.,
,,t,roiin,ri'i\ c,, nre{illnor,liu il!t.rior. l r:r}lltIi),r, ,,.i,. In.r d!,rrr .
t.rlliloarc. t, '; l:r t'.rcoper'.a. ztirrrjl nrit.,r t,ti,j,. ,,,. I,,rt..,rlIr. tir\;r .
degelelor.se r(,r,li7.citzti
cu rjllto rt It,li.rtiri. , ll {.1ll. irll,ri(i!r(,i,ri
rlltebmlul lri Di\.elul fl'spe(tiI..
_ . Lineo a}ter.[ r[rdit[lar prozirrlji rLtl.,ruulii ,1. tx,zili,r ii llr, ,r fi
gx,qiL5, iII $ntul Inlsrhrii ilr ll(.cnte (1rzuli, .,, r,, li ,.irrr,,lii trr t,rt,.roheru antitorniri.
l]]ulsul arlicrci c lt) por'+le 8ut)r it.irh n. irr rll.rrsut,ri si ilr rtfxrr
unghiului te polrl-t rl finlci prlpdnrrl(., t:r 0 rlisll'rir-r rlii ; I er,r
dc acesir.
!r l-\rlsrl rficrei f(,mnlxle so i'lr!to:rzn iD I'rlrll,,ir sIttrii,irr'r r lriurlghiului.s(?rr'll, srrb rca{lrr (r.urrrlii. Sr. rr;rrrfll.zrr 1,,tilrulerr. rla(ri r,
tirli':i .,,l,lrl .r,, tn ra. PrrlsUl rur,,r'r tnilr.,x-. ,.\.' i:,It:, ri,.r.,r:,
,1,'r's:rli :r I'i, iolrrlrri.
:! l,r.il'rItI' st,rlur irr,.fr,,.r.,r',,r-rr.,.
i: . rrl:lll :'rt,,r..r (r'.,ti,t,.t., :rt. r j.,r!r,.t
lx. ln,i,a.r,,ri,,:,fl'r.,.r, 'lcr.llt
,.u-ren15,

296

/ r/. / /r.

l,r.r(.9ulnrlfi lr nn.lrrl

I;ir. r.,4. SIi!nn'!r.i.

29i

Iormat lntre rDargines a,nterioari,

stelro-cloido-maBtoidiairulLLi

Di

I,!IinAc.

ti inrrgislra,t qi tto cirle irFlrrrmenlflld.

exist'i op&r':!tc specilrlo poatru inregistrixoa
prrlsului. Dirltro .l,oostcr. nrlolo reccl,linneJzi
e
continutr
srifictr
"pulsul pria inlormediul unei man)otc, il irlregisl,r,'azi clrrtr,'nic ,:i
Fulsul l,oate

In

uDele insbil,utii

frscvotrl,a nc un r'tldmn. Exisli, tlpxrlrto (,\ro lrLroui.l r'orzl

concor,litoDt cu frecYcnto puhului li l0!riilllrr'it rrxdi,'. jxr' i'.rr.tln_
tahimohul EoBizc&zd persoll":|hl dc ingrijito lrin s(rlnllIl,lo l[clLslice ii
hrmiloa,so fi asupm moilificdrilor de fitltrYorritr lilc lulsuhti.
Itulsul 60 v* lu8, lD bohovii sDilrtliztLli, irr rrnr(l rcgrrllL de dod,
ori po zi, ia,r ftocycnffu lui va fi nol:ltl 1r' to.rit rlo lonlporaturJ.
l,a cirero; medicului sau tn Itc4I, dc orie[truo, lulr,rcIl pulsului 8s poato
efectua qi do ruai multo oli.
LrL luarea, pullului se va lioe sealmr dc : frccvonfitr, ritrricitatc,
Yolum, tensiuno Ei celeritate.
F;?ct)enla piktttui poa,l,G fi lcnltr 6ru l,rtt'idri. Sc sl^biloite prir
numdrarea iulsatiilor pe mrout, cu ajutoNl ccrsului obiluuit, prcve,ztt
cu secunalai, lindt in mtnr libed. Dupt co s-a pllpat pulsul, se las5,
si, treacd ctioi_a puls*fii, phd c zi'icniturilo aloYro frecvente qi apoi
6e numird. Poqlru o mll,i ugo*rI orionl:tre, numdrdtoaroa sp vu inccpe
cJnd ar'ldlorul secuodarului arstd 1/l ll!-3i'Isaul minur iatreg'
Numarar.a dueaz"i 1 minol,, ias, dupi o I'rrtcli.5 oaro.f,re limpul
poar e f i rpdus Ia, I /2 sau I /{ rninut, itrmultiud r"zrtll xl lll.u 2, rospectiv
iu 4. Numirdtoaicr se ia lace de h tiqio t,ilin lx lilrio pe crdranul
secundarului de la co$ornic rii 3e Ya lnccpo toldotuur, cu 0, Ientl[ tt
nrr numdra inceputul ti Efi4itul tilnpuhri do d(,ttii lrri
I'recrcnla iulsuhii lr iilitttl siu?itos csl rlo ?0 80 pc ninut
Pulsrrl fii'nrl ricci.rnpt ilc conlmcl,iilo crralirc.. I11{'!l'nll! tui cnitrrido'
inslr\rerrornrl1ltc[lrocvcnltsidtolelolvonlrit'rll:rH.lrLlrucil iA unelo
cazuri ate Drioctxditi, nu toaia cont'ractiilc Y(trtti(llliuo sirlt tro,n8miBe
de coloana dc sirIqe ln sr8l,omul lrrloricl, ('rle nr"rrrutrLthlril ca frocven_
to pulsului (in r'a,rurilc suspecte sou iniliurllt'tt, 'rrrtic) si [Lo codrulr_
t:r,tE cu ftocyetrlia b{tdilor ctrdiacc.
fn oonditii fizioloqice, fiocvcnl,t Irrl*rrlrri IJriil,li {LIt'i Box'
vlrstl, iIUllirru.u, corpului, efor!, omolii l'ozili:r c,,rtruhri. .ltri fizioloeicc ctc, ABtIcl. Dul^ul fomeilor osto cu ? x I'nlli nuri frecveot
aoeit a,I Lerb^lilor-, epropiindu-se rrai rnull, do (ii'r! rtu, I'o cind pulsul
btul,etil'r so spropio tirti rrult, do cifrc;u. l,r hrrrrtio Ll!.rlitrtl,
in moirur

ii lransiirite

*"l"Jlllll:H'-iaz5
t,
298

i",1,itri

i,,ic

n,,,,,*
iil'"'i'I,,"
minrrt, t
I00-120
1''o

90

la 10 ani

le 20 de ani
(lc la, 60 do

a,Di

in

sus

100 pe trlitrut

60-80 pe minut
$0
-95 po minut

Lr ncreoanelc iDxlte, pu.lsul estc ceva mai rardelt Ia celssclllrale,

.ln l)ozili& cDlcat, pulsul este rnrui ra,r declt ilr poziiia gozlnd.
Lr ]ii, ioarc eelc cc1'x ma,i freclrent.
.l'ulsrrl 90 ac(elcrcozi itr caz do cfoft fizic BDU psihic,-in oaz ale
rrrolji, lon,riu[o nervoDsi. nrecum li lu curBul digostii. ]E ti@lul
iolrDului, dimpotrivl, da,toritri redllcerii aecesitdl,ilor etrorgetice ale
org.r,nismului, frcc\cn|ll pulsului sc:L(lc fat{, d6 e,ccsa ali-o Bto,rca clo
r(ghe. Din accqr rrrurir, I'ul$ul se r lua dinrinoDTo pe tromfurcato
dupii aleileptaro drr lireinl,e de ridi.are1t din pal, qi duptr masd, dupi
orele de odihn5, ins, iAailto de cin6.
.[n une]c cazuri erl necesar sI se ia frecveDla pulsului qi dupd
Jizjc, compnriBrlu-l cu hecvetrla I'ri ilinahl,e. Io acesle cazuri
"Iort
Be ra urm5ri Ei timpul nocc8ar peatru reyerdrea l,a heoyeota alo ropaus.
lnlegistrrrea ftecrcntei pDlsul$ se lace po foaia ale tempeHlttuE,
a bolnayului. Po ordoaata sistemulBr ale coordorate so va Dota frecyeDta lnfuului (echiva,lentl cu ntrmirul bi,td,rlor pe mi4ut), iar po
a.bsciB5, timpul clnal s-a Iuat puhul. La lniryimea linioi yerticale qi
orizontale, trase alitr cele aloui, luncte notate, se fixcazd, pdotr-uq
punct frecvenla pnlsului Ia ors rospctiyi. Pritr unirea ac$tor puncte
se obrine o curbi care reflectd oscila,iiile pulsului i( eursDl zilei qi tn

cursul imbolo5virii. Notrrea pulsului se faoe cu colneeld 6au cu creion

ro$u. Citoelc vaiolilor po6ibile a]e pukuiri Blnt ln ata fel tipddtope
loaia ale temlemt rd, c{l, litria groar,tr - considerstd ca limiid, tatro
normal li patologic - si coresputrali, cu o frecycnit de 80 ilelulsaiii
pe yuiout. Do aici ia Ells Bau iu ios, fiecarc litrie subltro ochivaloa,zd,
(u patr-u pulcalii pe miaul,, iar lioiile groa"so cu clte 20 d.e puloal,ii,
Dacd fteovenla pulsului perifedc nu corespuDdo Irecrr'enloi bdtrilor csrdiace, luaie l0, dvelul qoculti apexian, Be yor lmegistre lII
Ioaia ds tompolal.ul{, atit frecveEl* pulsului olrifnuit, clt ii freavata
tdtdilor carcliacc priEtr-o linic rotio iDtreruptb. Intructt lipsa de
colospoDdenld anDt6, iotdeauna utr mitrus ol fueelrenrci pulBului,
lrioBta va pu*a nrrmele do puls deficitar.
.Frccvonta lulsului poolo $i,
6au str seodd, gi fu oazuri
''rcascS
niroluAice. IE primnl c^z vorbim dc pul{ tohicordic, ixr h al doilsa,

*:,H:::#i
#Jffitt$,"'#t"d#f*Hli*r***sfl
lnclt nu poato fi urB{rit.
259

lln xxt colrrJtant, freo}eDll} pulsului cl'ci\te ptrrllel cu t{jrperlrtIr.a. Pentru {iecare g1:i(1 de terDl}etirtlrrt. ptlls[l creDte (tl I 1ll
}ulsal,ii pc Dlinut. 1'e foile de telnllcr^lul.i., crlrbi (lc telrperrrturi
fi curb& puhul[i nlerA de obicci l)r]r^lcl. ( r'(tlslcrer! (iisproport,io[tltat
a freclrolltci lulsdui frrti de tenrpe.nr,l.nfi rlenoli! cii rrllersta se datoIolte in afiuin hipcrternriei $i ltnei 1tlt ..rnr{, (tc obicei c,rdi ii,
* li pune ln giirdd, persoftrlnl do i[grijirt irr suNul rnei or-cntutlil
ir6rti, n,nt. cardiace (fig. l5:).
in urL.l,. ,rLzuri f,.brilp, rtisro'',lxrl , 'lirlr. \r!l,,ril, t,rl,,rlrr ri
r(lic[ t(.Ilpcr'lt.ttlri
illo ljsmp?mLruii se rlttrnife-ctd, lix urni invors,
ini,lti crl p[h occelemt in mi,slu:r, Irr'i rriliir' rl'(,it (xd co rrr [i corcsplmz f,or gBduhd do (ompemt,uri., (l{! rrorrphr, Ir o tonrpcrfl,tudi

(lc ll9', un }uls {l{r lrrlm:Li 16 in loc de 00 l,r Drin t cil tu li (1(. nlteptrrl.
Ace&sli stax,r loar'ti/ nnmelc d(t brrdicrrrtir rcltltivii ti s(' illtil rftr.

in lebrr} f,itoidi, Bi in unele mcningilo.

T&Lictlrdi* poste flpdrea fi in r]frtri n'l)r.i (1r, rrrr rr(,('rrnism df
(lomlensa,ro $ dolicitutui de oxigtrll l.o n lo$tl'Lrilor', rr)nrl)cllsuloir
realizindu-Bc prilr crclstcrc{, yitezci do cir('rrlulic, d(! oxorrrl)lu irl (riz do
jrr8uficienlo circlrlalorii colltrtilc str( potiti'li{i(. (nLi(x,r,r'rlit{r, cnrlo{irr,r(litc, Iczhui vrrlv inre, collps circulirtor do.). irr r,r!z {to ot{rrii ittiinhlto, hcl)lolrgii ribttnilontc, unolc inlr)xir'rrlii, l,r'o(xun ri irr cuzLLl
t(lburililor (rrrdillcc dc &rtrr}I n(.r\1,rsil fi ('r!Lx|rirri1.
'l'{hicxIJit! I)ottc si irpcrtl, ti rrl, fllrrrl rll' tr:rnrri'rrr". irr:rr',^r,'
(irizlrri, irr'cgiHtnuoi! pulsnlui 8c vr fo(]r, tlul):i
irnlifpClldenl
'll!r,sililli,
rlo liihir,r[(lio so
do olrur fix sl inr{lgistnirilrr'. (lrizel(. lrrrr{isliil'
rrolrorzil toldcarllra in foilc dc l,(!rrtx.r'tllrr'li.
I' l,s1tl btatl,iutrtLi?, &\ $i pulnul l:rhir:r,nli., I!rrrlo Li rlol.unir!,i
(Ir (,t![zo (,r,r'dii(r' $i ottr:|(.nrdi:r(](,.
)irr,rillll l,ulsrr(iilor. Iorr{e si
sclnli l!, (i0 5{) ltl l,o rni[nl sru ti r)rri I'lllirr.
l\rlsul b dir,rirdic r.t)1rr(. in urt'le rlrzllri rlo rrii!i!Rlil( r,(ir1\'
(di11,ctio5, lilicil), )nixedcm, i(,t{.r rLrcrrlr:!t, irrl,,\i,'rlir! ( u (ligitlltri,
rDerorr otr,., irr afrr.lirril( (rrro nriLki(i lrr\iIrnr irrlr( llr"rliun?i, cil
hornor.rlgir! (rrobrr i, tnnr'rilc inl.r'r[(r')llirl|.. rrIl, rr'llirtqit{' (,t(..
plecunr $i in c&z dc in'rtritrilr.
in caz dc trrlLuriir'i dc con,hrroro irl sirl,.rrrrl ifrii.iloti)rnhllrtor
fll ininrii, nuDr?ir\rl I)ulsxliilor'prr Dlilrrrl, thulr rri s,,rrLi l,inji Lr lJ0, JL)
.(x,[ chiar li mtii rntlf. ,{ocst grtd do l,r'"di(!nnli, rr rl]ri csllr in sLrlro
si, aprovizionczo orgr,ridmut cu singr'lc nrrrxrr'. [r rflrrr itoin,ildui
rlc oxigen ill cl'eier'ulrri ti chinr a[ inirrii, ,r,lnrrIlll I'ilr(t(,rrrroftintr!
(lrprirN de lrorll.ulsii to[ico-( l()nirc, sl:rl'l rr hi Iiiu,l to:rrlf grr,1_ri
li eslo
jnBolitri
do p(yi(ol de rrotrln! (sir!(h,llrrl .\tlxfirs-Sl,,kos).
li
-liirrriiiilalea. Pultrl l)orrtc fi tnric sru nrilllri(,. irl sllr,ro rlr)r nrIllil,
voltrnul li intctlsilrrtr':r tllrl&riiil.r'sint nnilIll)r, I)rIzok' (lilrlr('prl300

IL

iLi

1..
lr
tt

rl

i
l,l

s
N

Fl

'I

--l
I '--

q"*

,ti
-:

"t

ti

t
F

\
301

sfllii iiiud eg8le. Uo cirfpl de puld csle rirmic. Dacd Dslsatiile Du !ut
uuforme Si siDL separate iDtro ele de di.teDie in;gale, Dulsul e.to
drilDric. Nll putem rorLi deipre o rjtmicitalo pe ccl], intrucit ri itL
sfare .Eolrxald fIoereo!.r pul$ului m.ridzd r'u re6piral,ia. ltr iimtul
ir8pjratriei, pulsrl aleriDe mai frecrert, iar ia &p;i:r1ie mai riar.
Acasl|} oste aril,mia rpspjmr,,rie qi nu rr, rri,,j o nerrinifii,atie Dalol,jli.d, In majoritnlo{r l,rzurilor insi, pul.rrl lritnri. .sle deteiminr,
dF o Slnbolnd,vire ft rrio.flrdului rcu ft llcxrrrilor D(rrofl,so din jllrrrl
irrirliiDese.ori aritnria estc rrmarea uDei Nuforinio n sisternului norvojl
ccnhal, cercbro-ipinlrl sa.rr simllltic.
Pextl'u a Bosiz& stlrile ale arjtrnie so vor obaorr& htcnsilat.n li
Toiumul pulnrLriilor. prer nr $i drsranla c,rro Io sopffib. rlr.i!tnifl po r,.
rd 8e prczil]i.o (u rr,gulcritrlo. lipsitd dc
reguloritcn, sau $i
opqni trumni din cind iu ci[d. Din :r( osi,',rico
nbtiv, pentru iosizaren,
anitmiil(r}, de mnlte ori o8te neocsrr i o obstrvar: itr:ii hilolutrgal!,

li

sistematicr, a pBlsrlui.
Unco , pe lingtr, puliaiia nortnilli-! (riro inrr o silrgllld, ulrdd, s(,
percepe o pulEatic mai slabd (rr douil undr) (lo i l,(,isittrii diferil,e.
80 uumefte pulB dicrct. Aporrj in {{l[r! I ioidi, rnenii gru,v(,,
tr'bercul'zl} pulmol,lu,rtr.
^co8ta
IIr unrl(. imbolndviri rlle moaliaFtirt hri..rr l{l.r,rtto itrhatorr,oi(,
fi peri@rdicc, rD timpul itrspimriei l)ul8nl enl.o nrai rnic Bau chial
diffpare con)plet, ponrru ca 5n nxpitu!io dri rr'rrl'ru.ii t&rrm:Ll Fau atr sr,
itrtoDsifi(f. Din co'uzir udcrentirlur (ircul .lrrr vrlx'nrn r'sl. Arlnie-

niitr fi anlfcl in timlul insl)inrli(,i jninru lr.iIktt,. Illllu'r u.unrit.irr.

for,rte leduad, dc 8iDge. ]\costlr,0Blc Inllrul I) , doxrrl Iiiissnr rll.
Trstr^frrnorts u-Eui pul. Iitmj, iD lnrls Iritntir, . rrri trks ilacti
o81c iDsolil, Si do setrderca lorJoj clc (.orrlrr.lir. :r, iDilrii s:![ (u lchicarclje - dpDolri loldeaunft lIuiulilitl,rr fllxrlir.i lr'l,lr:ur., .o{r e
lrcbuie adus imediaL Ia (u[ottiElc rncditrrlui.
VoIrmuLmu a plitud; co lul' l ;I ,rrr. li rr:rr.( r. r lnll. t,:l .,.

micpreazi, pe me,sr)rd, ce no lndeptrrtllm do inill[i. \irnrntl lluls[lni

este alel,erminat de ca[titatea do ri[go Io (,rfi, irrinr:r (, tltLnci, i]r
artere in cursul utrci sistole. Din a(cBt nroiiv, cl vr fi lol d.amra (te
anplitudine mai mare clrrd inima [orrna]h $li[ hil)r rofi:rtii hl|r.eart
energic Si nu esl nici nll obstacol ilr (ialca Hixgohi. l)inlDotrir.i, irr
ca, do tahicardic, clnd tjmlul ldectal po[lru untl,li]rrll. dilLstolicii l
inimii o8trc prea, scuit, i! caz de (lebilital,e (ordir.{.i. a u o unui obstaco}
iD .alea slngclui (do exemplu Nlenoz, ao icd), IUI*ul osie mic.
In erz dc puls mic, el Be !a palpa do unrbole plr(i, cunrl'craljs.
Afecliun,le caxe aliminueaze Iumenul arterelor piDd la rudiali, cs:
tumo le, cicotricilc, enda,rteritle eic., rea,Iizeazi u[ p[ls asimefuic,
302

io,r dp pJ. i a sanili},iT,il,nrc. i "rprlr.1, r dilito,ui..

ctrtpreDli de tolutn noarp ni
ei lDrrts p,r.';i;;ii;i
'
itrieriorrf. ld i.'n, {ie
,ru ro.:rrzrr,,, pr,,."su6ri ,;";,il;i''xfr
i

I,ti;lt t
x,.r,

rnorbid. tr0'mbreior

,u1T;ii';[H::i:iii^iri:i;1ll';'J; lH';,ii;

1],ii,l' ll:Y',

o''i'"

ri durd srrr rnor,l. Ea csip dpr,.rroitrni,:,

.L initni;. ,Cp.""i"*o.r*.lr;, ii
f,,-,f .";ii

.,.. v:rtult,rex
.. !,::::iir"* .,,!,!,,t.?i loaro
rLr
torltsi dc contrcctio

so.rrt.i'

IrIn rpreciorca fortii n...ar.r

',,ti,,t". i',,r.,r ""io .r,i l; H,;i;illi

!!rLrlrrrrutur

sr LDs.

rurl,irrso .ioseJo d-in

ponr rrL corn

prin':rrar a rr or.i
inro{ir" J' lripprrrorjr

Accasrx,,,{"".,^ l'l'l't'l
,;;r""i"ir,iiiilil , illl,l,,l".,lr ;,Jl;ji, 1,;,:lil.:,

;J,',J',:lil:l':"i#?;ii;"f,,r,igxl,T,f:JJ;[i'i' ,r.,i.i,'ii,l"r"'i,j
cl.crildlca

...(
:r,.1Dctor.

if,"j,i"

!,ulst,lui rglrezhte iuleela do riclicaro ti alo cli$Daritio

putsntilp,
coo:r, co r,.prcziriA in Iortd vjtez.r,
a"

"r,iili,-,ii',il

.,1,1:-,t'."**Hd{,,*\i#"','lJil'tin,t.;tt#fi

rrura. rrlurJ'otrivtr, lD coz dit sto[oz[

$
o,i.,i.a,
o*i*tn-uu i.f.uiJili
rlt,
sr,lqolui!
n
lD
nnz
]roel $i
"i,,a
du irfonu\l.t,,rrJzrt,
'r1ron
.diu mai ro.rt$d, pulsul or'ir o a,",,r,i',liii cJnal
'r_i,g,r,olustici_
"r.lilii

:.1;::,,,I1i",.
.,.

. .*ll^lin taclil[

ub]inlrri

oe.!zio Irrtptrrii !ul"rLlrli dcl,inde

jlilii:i:fii':J
ii-,1,'":, l'flill l':"d;l^:ill;, * iil:*j:,* If
rrU (:!(to jn ,,ornlctonil!
osiib0[toi. ltt
t'rnboin..9x ouoor.cr

.,r.:ro r,,uzrl1 r,,.rilo dotornrinrto r,, ,""''t,t.n*

irr''u l'orulil"r urrodali.
r,,rr,'r.,, t,uin,, ,p..;r.,'i,"r,iii.i'r,.,i" 'nrrltrrr'
rr,
n.ei botrrrvi ,.rro prcl
tr
z rrx diri.iir,, i*d"r,,,i"i,.i
"rI.\rlr""iJ.*,,rI
...,],]:,lt,1,,.trrr,,t'ulrrL,.tuiotsr,,bilirdr.It,or.lii
rrn lr, ru I'tltolorice. ]Irirrn vr, fi ,,n, rn,lJx.flori,rti nrr irrczinti,
'.'i cfoi rosrosolird
P,.r,,,r,eio
*i, ojo '.r"lPl
'rrIr.,1,;ot,..
uea rn Irrod
uurmll serz:11i,,
r'l,ri rllir t,,dp,.r
".i"''i"'r",
ii*iii
,ii"ii.l
po''
piorde
ola.r irirat;a,
1,,r. ,rc, .rii rigizi,"rr"rr;.
lrin i";;;;;;";' i;;' :': '.1
ba,rrr rDin"rule do
rrrgr.l:r,1,i,
'alcirI:
'inriogi. droairi"lrif" J"""-,,r]u
i"oti"n" ti colorilxto
a,, vor.rlrr,rprorx
fu scecro .ozu'i i,r'1,1.u9'.on',
lr'Up
dr
rn"tificrrilo
onatururco irr. p^r..trior

ario-rirli

RESP

MTIA

oliggl renp,icr procosetor vilale alc orgaoisrnutui

.,"i_*ojlllt
. .--.*. so:lsrguru
pnx respil lic. Eo io.iude urmitoa,relo
de

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303

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irrr'l{'ru r InIDoIldre.
':. Ltapa n g.ni, |1,t,r,,zi.I|ri ii .le s,Li|lrLrrrit! .t,. r:.zo dinrf,.
:rtIrl ar\,.olirr ri siDjjoln tli firl,rt:rIpte ,.ir.Ililior rr,i, i. triiron,rt
itirl
i,, r'lll r,jpilrtl eslo J,r.,l:rr : rr,.hri, :rceila rL.brrr..r"rrr,lrr.r. irr rrtt:r,i
rirrp rlr I'ii,sirhrl iL.,:,rlx'rr rl't,, r,r,n.
:t. hlapa. r-,irqlat,q-i, r',.1,n,2,.rri:rri ,lo lr:||rstx,r1lll orrjr,.nUlIi
l,rr, Ir(,.rItIr.i .)i x l,i,,ri'lIlUi rl,,..i,rl,(,',,tr t tcirrrrrlj tu:ti\,eot,.L.
I'ulrr,,u,rr. pcntnr .lin,llu,r,.. I'riI rrurlilir:rr,,|l itrrtnt,Ili,.r . ,r,.tui
ur a,r,jrn,5Dr.
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lrrirxt rlchitxl_cir,-uli,li,r
(inIl lurt 'r,r,.
l rtijiritrl,.r or,r:;rx, ,LIj,ri ,,,.\;,IL, rr,.r.;_
lxricr nle a(est01,r.
i;y/lnr,i.r,,l,t1.z0ut ,i dc rrhi rt,rrl rl,. X:r2,. ,litlrrr ,.iIS,.
, 1. .I:lapn
cu :'Julr.rui trnui \istpllt ,,olttlrI,x r,,lzlIl:rlt.,, iI| It.Itil I,lil ,lr.stllllfl
Irlrir oxrgeDul r,.tr
I.rlltrlrilur in \rrli.rr:r .i!uttirir rrrxl,+Lr
'odlt rle
.lc Ardcro, irI trrorirlrrl
( nr.horr c\lt in,1,rl,,,r.ii i 'rillj.lr. ,u
s(\)pul dc { Ii diDrin l, Drin plltllirri.
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"rrul)lul lor, dnr in lirrrtr:Ljrrt clr{nl l,}irr ,,t,{r.r.r.irr,.
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iIlr.k.g,. IInrri
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P6l runderca renllu i iIl rul i& to],ti(i(d Irillrl ill Irr,ro !ji olixrirlx l,c.t,
_
lui iiDt:,.igurut..I. lri,j,.:trilo,to di)rtt,i(.5i,f,.r."r,.rui.,.,,f"-,.iiiiri
I"r.lcrc!.
I urr,,i tur,r,.i(r (itrspinrli ) ,,stc :rs.{ r..rtii rD.jI
rrrrli.xll _I)ilnlitretl
Insl,rnrturi :j itrsl,ir t,r'i rrrr.ftorii; rtr.rrrir.,:r r,i tr,rr,irritiat
it, lir.c rn IIod t,x.i\,. ,lxl,'rittl cl
. ;i rhirrrr,i rrl
r
i
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I,a.J.toracflt! ti-r I'i,.I1tIt ,.t rrrcilrllo:r
^ti(.ildtir I
,.,,.,,.i",,
,,irrr'iii
't,,(1l
(nA i'lamlDl osle IlII'ir,'lir:rlit rtr, un obstnrol
"i" t,.
r.rlrL, :rr r.r.r,,.. r.rt,rr.rlrir 3o l,r.c r.u tlj t,,rul ltlu/[il,'r esIinrt,,ri.
_in \trllc nor,tn,rli Bo Irrco liuittit. filii rirj ull of,n1.
-- Iiespit,iliti
j\'litcirile
cutiei tor.rrri(o Bint sirnotrico, rilirritr, fi ,rt,i" iiriirii;.
r

I :

r r

r r

Irorr.fnl^ unrnr:il:i- (:t. rl.. lti :.tU !,, nri rrt ,t,,i
rrrjoar'r \'afllllii rl l't r' \ si \,ihtr:.

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1",,rr,. 1,r..r,.i,i,,

li Irr" rerrlu r,,it.dlitur tl.rr,rr.,r!,r1r ",. r,rtrU,r!:,2.r

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nFrr .irilin.rl..,,riq, 1r..1 91,.,1',1 rt,,s rrI|.xti,.,.l' Lr,,rrrl
rrL
rl \rDgHrIr tr rr':lllur.il,r. t r,, t,r,,,c.rJi.,l,.I{rrrrl,,/x t ,r ti rl,.,luIl,
rl,riuri:,,.
rrl rrrrrx'lr.rrl|.r I,,.r ,. \r,ri:.r. ||l]t,Ir;|11,, rle r.r..1,ir:rIr, ,,,r ,",r,.,i.rr||
in,li, i,r,iuirr'. irrr;,,r,,,',, ,.,,.,.r,, .,,,r,,t,",, ,i,,,..r,i,,.ri,.iir,i,, ,,r,i.,.'ru

. | I | ,,,r,t,lr,. rril,,r. ,., .; r,,.,:r,,,

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rrtr,r Ix. n,,,.. ,1,.r,.r,,ti.lrt,rrn ,r Ir,,lujrrului r,.r,;/,r,r ,,.,i,,r,;,l;i,
rrl' ri.. ,, r ulr'. ,1, rI! j;l,|. r LulDl1\lrltri.
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t,rr,.rr,,,, I\.Illri t,rilr
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r,\rir.rr,,rir r,c r,,;,,,,r
,r,r r,r.., r,Irrriralrllui r,,zi Ir.,i jo.,. ri,rr.r..,lrrl
,ol):r:rrrrcl,,r. fiziot,,:,,r' rIl , rr\ r r,oirtor r,'ri'lji,. ,1,. j|lr ii, r.u(i ri..r,ir:r,,,rir. r,ha.ur,,
,r r-, .llt l,Ilirjr,. r|ti,r,r,rII,t.,\,., r.:r: jr-,i iiir., t.,trrrrrt,,i ;,,,,,,,.,j_.i
''rlr.,r .1In.,l, lriln. r:r{i,..:rrr,,.r|zi:r(i nrc., , . " i :i , r r, t rii ..
,.:,rrr,. .IrIL,|||:Ir tj r", ti|ll||t rrl r,,rrrir.:r(iti,
r r

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ip:r .l,.jrr iIrlri.rr:tri r,,ii

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iirNir.
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ti ir1r.\eIll r,.rr,il..rt,,rir.,,,i, rn., rr.

fr I e|lriLll{ ir :, r,,.rir h ;i i-r,.

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rLrr t..lr Irr1.rr, l,.i l,trlB hri. 1,r,.\
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Il
irrnrl rl{,zln.icri1) sinl :
r', I ' p l. t-txt,,rttta. tlrIl rlii.,rr,r,1r ,.Iri..i ,,,riu.ll1. -,, Drtrcrr
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'r, 'tI clr.t,. ,.i.
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h irlr,:rr Irr, ri,lr,,rtt.r ;i l,r,,i, r,rr,..r i,,,,,i,r,. ., .i,,:rrlrr. ^leligr.
l,trrb{li .o ,lil, :i , i r irlr dirirI..nIl rr.r,r.,f'r.rl. ir}i i,
',,rt,rr rrL:'_
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.llr. i..lrI In(lr,
11r rlri,ttutl,,Il ..tr, tulbur.rl i:r furrr.{iurr,.:r
,r llirrrr:rruirrn dc rrrirrir.r,. rirrrfrz.
t,t.rrr:i1,., ;,,,,i;,,,i.;.;;,., ,;:,;l;i
.,,1, r..'.r,,n. 1,:r:..rtizirr ru.r.vrt,,r. frlrriri .r,u
ir, ,.,,, ,t,. ,ti";,ii; i,,,,;;:,
Iri'rt',I,rrt. r"st,ir.,liir \.rr fi "r tir Lirl, i ,t,, rir,,,,"tlii
*r,,...j"t.
rr,\,r.. In,:r/.1,,
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nt
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tr,,r, t,,rir,r,riIlt L itIIo uurr ,rli s
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:,,r'r'lrt.,li j,.ix.jr.r,.lIi 1,, rr.j,.s:,rr Io t,l,:Ir,.i. irr ,.rr7 11,. 1,,,..,|ir;,
r.,n..Il,, rrii rI' ri h,.r,rir,r.:!1., t,rr!,.Irn _oi rj,."",,,r,.*,i ,fi,i fiii,,.iirr,:
r' r,'r., .llr t':rr(i.rli rr rrr,rri IlrirrrirLr.:r ,i irL,,,t,1(i,
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t, ,l, l.ll lr,rr,,Il(:r ... l,ir:rlr,,i. II:rn.,ril. rr,,, rrr.!.r r... i rr,.r, r,
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:r, t,li r,litLilor r,.rt,irururii.
.

305

t ifcitilor rcspirdrarii io st ro liziotogice, .,ito rn

" d' l]:p?tp"fo
luarlio
do rps, virsti., pozi[ie, cctivitar6 mus,.ul.,r:t, iorp.r"rur.,

r,pdiului
precttln fi de AIxre"a do veglle sxu s(,m;.
-crxbianl.
Lr
bfubali
hcveD{,,
reFpira,Lici este do l0 pe rrinut, iar h feroci
.
tlc l8 -20. Dard frecvco[a redpira{.iei se acrcleroazi vnrbim de rahipnce, ix,r in caz contrar, ale bmatipnoo.
Lr uou-DiscuLi, nuutirul ilrspirotiilor osto d. 40 ;0 r,e minut_
.(dzird irepial pind in jurul virdtii dc 30 do lni, r ind se st;bitizeaza
la, ciftele dc m,.i (na
- Ir pozllie cul.ar, lfeclenl,* esle mai tuiftl d..it lo oozilie sezitrdTn pi.ioa,re. DumdruI rcspiEliilor creEte Si nrxi nrult.
A.riYilatcn rnuscula.rd, [ecesitinil uo aport lai mare d" oxiqptr,
provo.Lcd, o crcltere a lrecvelrtei nr.rcirilor]6dt,ir.ltorii in raporicu
itrlensitalea cfurl,d-ui musculrr. Dimpotrivl, io sonrn, numirr;l respimliilor scade sub frecaenla coD$l.attii in it]re de ioshe.
Temperalura mediuloi ambiant ioJIurniaaztr tre.ve;la. Creqlplea
lempcra(urii uediului ve deleruint o crcltero narcJela,; trec;entei
tr,iSr.irilor respimtorii. PoUp[eea, cpirl|t l:! o temperafurd mai
lnaltd... rc?rezioti, uo mijloc de picrdr.re do rildur) a ;rgedsmdLLi.
.Exi.ii ifl-mod Dormal un raporl, constant irtrc frecven(r, respirdlipi_qi a pulbului do 4 : I i acesl, r*port, I,laLc si se moditine Ioaite
mnlt lutr-o se e de stiri patoloqice.
-flumriraroa, mi!.irilor respiratorii so fx(o rirnD de I minl1l
Intreg, avil1d griia ca, ot'crali* si, s. fai.i f?irtr stirell, iolnar.utui. cj.i
Iespirxlia esle u11 act roflex, iorou$iient, dci r"ourroler de vriirti.
dill carp motiv boln.Lnll, obsa.rvi[d r]a i s,.nurn:tri, frecv.ura miscirilor re.liratorii, i:i poate modilicll rilmul 6i ,sllel nu se rili oliiin
veluri ]eale. Dacd esie posibil, nruniritoar;:u us va ttco io tjmdul
surotrului; oe-ra a$cza mr'Da u$or ou fala pilmftri pe suprafrfa loiacelur DoiDavulur $r sc vor trumtrl insoinrtiile dtLud rnisclirite,tp ri.ti_
rcle a perotelui loracic (t;g. ti3). Dactr botnir\ ul oste rrexz. cotr_{i,ienr.
alupi lerminarea oumifiiiii brtiilor l,dsului, fari o .. pr,a"i
boloa\.ului, se vor trullrhr&.:i miScA.rilc respil.lttorii. urmitind misci^ind
rilo ctrr.ici lor&nice sar ale peretclni abdomlDxl [lrrr:r,i prin iolpocfip,
f5ri qtirea bolna.r'ului.
l:rpclerla lesliratiei se lnrcqistreru.i iu foli:r, ilo tcmDcratufli
1a let ca $i tempcratula Si l)ulsul. Gralicul se vll, ilesent cir creion
ftlbasrru. Culba respi.rBriei trebuie ntr meargri, par$lel cu curbe de
lempereluri fi nurba pullEloi. Cele trei curb loregistrcazl; tcei
fuDctii dp baza alle orgsoi8molui: circulalia, respiralin ii termoreglo_
rea. Orire iDcru.i$aro furr6 aces{,e tr6i cdrbe semna[zeazi, o abaier,r
iu funclio orgaDelor sitale Si [o.:Lte si fi indiciul in.taltrrii uoor
cornpliclllri.
306

Frc.Tc([a re6_pim(iei nre$te in caz de emolii, clorl tizic, biperliroi.tidDr, in siari febrile, ln oursol bolilor ideciioasp acutc, itr aleclirnrilo ncr(.lilor tora,cici, ia bolile rarc neduc suprafcte rcBpiraloris, ir
:lnomii, h;moragij, iatoxical ii cu orid de carbon, ln botile i[imir.
:,I.rinirhiului. 1n {,oal,e a,rcstc cr'zrDi, hematoza iitDd deraajald,
()!qani$md cauti si compen8eze
dcJi(ilul de oxigcn prin cleSteroa frecYenlei rcsltiBliei.
IrccYeDts reslimtiei scaale
io caz ale obstacole in ciiler6lintorii Buperioare sau fufcri,,arre, i1I tumo ]c meali:]stiDale,
jn caz de pierdelc a elnsticiti1ii r:ttiei tomcice.
e) .Erirrifltr. Ui$cgnile respimtorii ifi pdstxeazd, itr stale
normali, lln ritm .egulrt, impimriile !i expimtiile succedinduse la inteNale colrstalrt. [Gitrnul reBpirator poat li tulbum,t
I tr atilgerea, cont lor nerFo$i
decauzetoxice, aut,otorice (heIrtice, rcnaJe), infectioeso, [eurorcfleae etc. in aoelt caz, aulomatisDul miqcdrilor respira10 i este grav fufburat, mi{oxrilo respirato i succdinalu-se
uorcgulat, aritmic, tlezo loDat

.is- ,rr. - Ntrmnra.ea rspiruliei.

(r'czi,,Disptreea").
'
In ullele4azuri de obsl,acole tu crile rcsliralorii, inspjralia pro'
hrr,eili $i proluad.i poato li lnsotild, de un zgomor nrmil ron,rj,
r} l0TrniDat do I rccenes afnlui prin portionea slrimElA.
In cazul exislen(ei uDor obsl,acole ma,i ifiporl.lnte, in Limpul
, l ,rr oritoi de inspiratie nepotitrd inlra o c-*oUlile butirietrrA dp ;el'
i n plamini, coreEpulzltoare grailului de dil.rtarie & toracelui, se creeazi
o dijoronli de lreaione lntre arul al,mosfcric Ai aerlll inlraalveolar.
Irr \,cderca o.bilibririi acestcia, Tidul rel-a,{.ir intraloracic, crear itr
l impul insliruliei, va aspira pfugile moi al6 perete.lui iomcic, determinSnal o doprimare h regiDnjle supra- qi subcJaricuJard, epiAaqlri.d,
l,rocum qi ln olaliile itrtcrcosl,ale. Acssti, mi8ca,re lanadoxrl; a pprc(ilor toraeici. rsanifcsla,li pritr depresjDDe ltr limpul insplru1iej, poartd numele ale ,iroj.
30?

,/.rir?r.,d. Diferitele nn'difii:iri xle reslir*tiei rru xl){r

ill {enenrl

izolrLie, (i se combini i[trc (lc, me[ifestinaLu-se Bul) forrno .il'Iacler'isti( i n alispneelor. Pr'in rlislrxr, se intelege respiritlie grtlr. subiectir.
1a sl] nranife"rtd p}inlr o selr riri nnrlt silu n1ai l)utin uc.rrtu.rti. dt

:(r', iI! obiectir- prill milcirliIospiratorii fortite. fuloir ite fter eslr.
rt{,I(,urintlli de en.itrti:L c('nirrhli rcspirAtor l)rirr sitLlole iuclrcrt

bio\id tle carbon srur (r'crrl tllll de alte substantc str:iir(r (ore circtrLl
irr r'inge Si relrezilrtii r+rrnfllul do sLunrd, ltl deficitllui (le oxigr.R.
l)iD xccst motir, (li'rl[({,x, o:L Ei rltorlifi(irih clonr{]rIl$re rtlr ruilctirilor respirato i, 1'or fi rlrlet,,lrirlole nu rrlrlnui d{' irrbolniyirilo al}tlnlluhi rcspirator, (i ii dc lorlte rfl]cliullilc (arr tulburit schirnbtrilc
norrn$lo ale g ze.
('il(l bolnarul nu rniri lolte indepli(i eforlrlri do rcspiulie rn
Inu$chii utilizati obitltuit, inlI[ in *ctiune +lti r)llll(hi. tlrrc ilr n)orl
norrnal nu parliciplt lrl proccsul de respiftrfie, cl| : strno-cl('ido nrastoidi:Luul, scalenii, diutatrl lnrrc, peclomlul r)rrro ti r)ri{, rsi (Iintotul
Illic, cilr'e constit[ie gnll)r mutchild lcspirtttorii r({]eso . I'ontru crr
{cefti muschi BI-qi glN('nscii rrn l)umt de sprijin fi! in vcdorca dih11'trii cttiei tolacice, bolnllvrll so yl,:L$cz:r irrlr-{) pozil,in forll[tl, Dllrrittr, orloprree, in pozili(, ricrilxl, rlr cnpul {i lruu(.hiul rllccrt{r ioLr,ixlr
ti (xr brajelo fir.utc in jor, rpriji ndu-sc do ('l( lx,(lur r! t,rlo iruobili
zo lullonl.
l ltU)i f rc(\'cnlx. :uuplil udinen lsi ril rui(,ilril rx rcrpilrtlioi, cloosol)irll un)itonlcl(! lil)Ili (le (lispnoc:
(xr

1. Dispfi?c (

a?(al.ratca

,il t L i r.spi-

ec (

td1 it?tr til

ll

l o , (lAhipn(.e snu txnilnx{,1. Ifrrclrlrlrr roit)inrlii,i { sl(' nrhilii.

xrrlplilu(lireir ruir.ioIrLIn. r(,spirrtirr oste sul)oIfi( irlir, (l:ir rilrricL
so iDlilne,\to in lorlr (rzurilc dc lc(Iu((,rc u srurrnnlri respiflrlorii.
lll l)olik laraliri(.. (,u( 1ull,ur'i hcD)irlozir, iD uuor'rii. sliiri lr,\i-itf(.r'
liorsr, }rocos(, iIlllarlnl,,nrinr]l('c^ro r'idicit l)irzr l)lirrlrirrilor ii rc(lu!
rslf(,1 srtllafrIi rosl)iru,)r'ir.(rutlrorislr). 1rs.itii, ritlrin[ rl(.).
r

(!

).Disl

i ,'t!litalol

(l'r1r{lipnee). l,'nn.vorlri rrslirutiri lorte sI s(\r(L'L ln l:.i l0 -8 sar

chiu lqi rnai puli[. l'tl,r:rlol rrr $crid{ r'{'1l frcc\'olrl.i ( l'(!fl(! rinll)litudiuoa,
iilr inspilaliilc dr,\'iD lnrrhrnrlc. -l\ccrsti form:i (lo (list)rl(ro so ir\tilneftc
ill crz ale oLstrcol('in ciiik.rcsliEll,orii. Bmdi!r(\lr! Ix)rrl(! [i dotornrirlll'tl do deraujrrcu Inzri inslihtorii sau r! fr\zri ext)irulo]ii rr respirzl1iei. T'e baza rxrcrlui (r:il(.iu, irr.:rdntt Llirdipnooi (lcr)sflirrI dispneen
jDsliratorie li di6pn('(.a ('ril,ilirl or'ie.
a) ,ir/r?.d iis?iratori. RaL b dip,rcea i|,pit.ttotie se c&rocte-

lirexzi, priotr-o iftspirnlir gles, aneroioasir, forlrlln, coDltienttr. cu

l i(.iDir,r'cir r(tivil lt lu(uror Dln*hilor &rcesori. Iir. so iDtilDette in
(,ru (Lo oLstucol al ciil(,r resphato i superiorro. Irlspi$iii. cst iDso-

'l,

308

liltr (l(,(,(,rrrLi iri tir,rj. -\cr,.r liI (lr rcspirrtie nrai port. r|irut ii in
I x, (1, p1r'xlizie incollrpletri n r,ichilor re,\piatori.
l)) I)is/nae( etpitdloti! sdr btdip)teea erpitluti. sr! ('irl'Ircttrirurzir l)ri tr-o inspirJlio [rli\ Ir)rnrillii, urDrxtii do o (']rliirutie
jtr\n, I('nibih, fo4rti, Lorrilir'rli. zgonmtoNir itlsoliltl lnlcstl! de
llrr ]jr{,rnit. .{(easti, forIIItr rkr rlisplce :}pr& iu caz tlc obstrlcol in
(il,il) r(isphlltorii intoriou,r'c, r'l! ill irslm brcntic rrl.[ l,ronlsiolilii cu,pihlii (sl)rltr1rd, resprr'tiv obsltrrclit l)tonhiolelor), l)r'(,( (lrrr Bi ltI crrz
(L) cr)zifcrn pulmorr: , (in(t lilsr rk! ('I!xtiritrte x plirtrillil(,r i,rtlri{xlici
rllflrrliri l{,r fizic,log;c{, rtr.(,siliu(l ir!trl1'cntiri unor rnu!\r'hi (.\l)im-

ril)rild fi terio:\. I)iltpltc( (t t(tlntl,atct

ni.n d tespit,xli?i. llrspirlrlir lirrdc ritrxul {i rl(r'rrxl, ilrsl
!rrrlifLli{rile cart' crl.rtctcriz{'azl Irritllrilr se nltni[('sti[ (tul)ii o I)c_
ri(xti.itotc ritmici. lilc se dittorer( I)erlrlrl)irilor fullclii)Iull(' ale
,1,rrlrik)r Icspirrrtori. Ik'r,s(l)i,lr nl.li Drultc fornx' d(' dispnt't (u p(rt rhllxc ritmictr ,ri p{rriodicil r\ rrsl)iraliei:
t) ltitt, eed t h?.u "-rl"ks t'rt(' f(,rnrxti diu .rx1(*irllrr':! 'ri'hiiL
xc.l.hflrlri inlrl,rul,lr, Irrrn s(rlrr{ 1.I Inr'r l,criuadr. rL' rr.rlrirrlir.
ri{rulo do apneo. trlili({ril(. rtrl,htrtotii iiot lt intol'lti stll)tr[i('ial(',
rtovi,r up(,i din (|e iIL rc r'rri turrll('; p+r'iilel (lr Cl(]!tl(rrer! u,ItLl)litu(titlii'
(,r,rjio !\i frc(\.eDtrL l,)r t,irxl h nn rt:lxirr; din il't(rsl, nxrlncut iII(!(\)o xtr
{,t',{1.1, :rril frcr\rDlr'. cil ni Irrt,litrxlin{:r. IirJ {r'ic irrilrtlcrzrl r' nerl{.nl,n.,.rl{;1 ltl ,1. rtrrrrl. Irr 'rrrirrl t,rriul,l,.i (tt trtrr.a.
'i,'rB||i
i. r,,ll|lllrl(irz:1 itl sirrgo rii loruluIi l)io\i(t do crlrbon, crlrt cxcilI

rtrlrrll rfspil'{t(,r li ciclul l{'in(ol'..

Itr{rrirniit ('[(,] rtc-rit{rkrs rrt)rrrr in rxz (lo inrlxrLrii\iri insolitc
rli' lilr'rt{,nriut}(. iI\l D('r'iuriiLnI rlt I rllrlor'i 5i ht'trlotrrgii tcrt'buili"

rx.rir{ilc, ia:ritrli(,srl('r'ozit (('lel)nrli. ill,infiritlllu (itluIllrnit" },rc_

( llrr fi ilr rrrctllii].
lt) l)i$ll?ttt ffrirsarrrrrl sc (rrrrteriztrlzr-r I'r'irlrr) llrtid\nree
l,'rrl(, rrr(cnturt,i, (lI () irrsl)iltllic Ir,fun(ll ti zgr, r,l,,u,sir, utllrltir dc
o t,:r,rzir, Iur*ii lqi al)oi rtc o r\piftttic lol u$L do hrHjtr (:I ti ilrspilatii.
l,'rctvIrr1rL mi,\r,iril('r' )(sl,irLl.orii potltc sri s(tl(lI l)iuir ln L0 {J $lrt
,\i !rlli riult. sr corlslnlri in urz d(r hip(|rlttrsiur(' ittlrrt(rritrilni,
rhlilt r jrr:r\.. i,'tri'li:rlx,li''ri ar g,,rrio.

tl ltisltttrn .lior(/ixl st (xrtr(terizerzi pliII inYorsnre.l tinrUrlui

r,'tt)ir.rliri r,'ulxrlo. ir st,lrsul Prlurgirii irst)irrrtil i ftlli do o e!pir^(ir! r'nlll r(rrrlrlI. ('i(hrt r.rpil'dtor este forrnirt dirltr-o iD8liratie
lungl fi forlulri, unrlrlir 1l(, t,rrzn reslirxtoti(j lsi dirrlr o expilalie
lrrus('il, irurri, ,lrtril calc urmcazir - fnrn niti o pauzil irBpiralia
ci(lului urn[tor'. ( nturile (Ir respinlie de tip i[i'or$ sc repete in
rrxxl ritrnic.

309

.Dispueea BoIcbul. csl,o insot.iti rle obicei de b;liile rrioilor 11r.

da .ia qoz;. Se htiltrc$te ir b"..t ;;;";ir;;;,;;];i;;,"'
"""
.ri
d),Disp,ceo
,Bio{
se
caracl,ffiz.azi
prin
rnigciri rp.nirxrorii rir_
. oe alnn,rirrdroe
,rr(e.
normatii, alar despr, .ile dp po,uzi, mai luuei
dc I0 -30 de sp(uDda. DispDcor Biot sc r;{,itiresr. ir',i,"","";i.romat oace
^,ii,l
.qi m &gonie, reprpzent.ina sua iut pi,"ier ar, r,iu-A. de'ie#i
,,4,4 (re ECaoete{}
acfcBtrrr.ti a esoitabilitSlii rcntrului respi-rator.

Frdui

.4.

-D;.s.p1t.?ra dezor(t o at.d,. CiDd ro.riratia nrr rnri

I,rezrnra urcl o rrrrnr.itrie sau lcr-iodieitctc ronstarrhilr, Forhim ;"

olsJ'neA. dezordoDali,. IfiSc5,rile I.e$piralorii au
ernotrru,tini a,r",ir"'
-a"r"ni
de,.lpt:la.tc inesajc, inspimlia $i
p"L
:^e:!l:!Ic
Fxl,a-uam, rnodurrarUe nu se_ repet.i,la ilrlen.ale "*piinti,
deiprnriDaic, Area!tA
rl,rrna oe or.pEee e6te de obicei exka,respiDtorie.
fiinrl. determtnc,i;.
oc oorpgtxrca gra.r c ce_El,rilor respir",l,ori prin difprite
rraurcne (eE.pla!te. tunron, hemoragii cerebrale. orocese ini rq_
in;ohliel- tdrJ
rnrc.lroc.sc (rnro:ica(io cu alcool, nroooxid rle cerb<iq.
id*iii'r.",.,
urrorr.rp lrDqutrcrplrta hep.rt.icd,li ren: d,, apidoz,p aeren(uarei
sa; ncir_
r'ol,eflexe rourcrr loalic :lu.entrri,e. etnolii mari, sau stir,i
dp
tunorria_
re oer\ oabi plc.).
obsema coDdiliilo de produ.cre a di.pnoei.
Sub a,cebt
__- l.,ro.
orstocca dc clort, dispDeca (lo de.Ilbir
si dispoee.!
l,Xli:;rX.:*..:

Disp eco dd ejolt indicn sctufal.ia itrs icieEli a organibmului

.geD,ra
cu
impu I elortului dal ori i tolburdri; s", G""ii
ircr plumoEare_ Aceasla poate fi delermiDal,j de o imbolnlvirc
"t"ii"i"rfllfi.
I aparalDlru .rft ujal,or, lie a apa,Dtului
respinator.
dffultit .^!a,rc .ia pizitia cul.al, ilir cale motiv
,^^.!-,:p_,:":!,1:
IUpuIre
DorEarulut o pozilie
qezhd.
oxr

DispEeea dc decubit tfnder,;_

c,rcr alie jmuficienli tD plaminir dc orjgine carail
alar 6au prrD pro(esc pleuo-puloonare sau diafrasm;tlcF. n;r"
rouc ,_(u pt a.tala r.slriraloric priE comprimalea pcre-ncbimului.
up,.uDrr oorsat. prerirLDeaL infmobdominaln ridicn diatraEmDlir,
qi
ornprimd $i mri mr i ptrmin,i. fo.a"ere ioi;n* ne-Jur"iixli."ii,r,ii
'
cx-e' uri n jr.eri maj drci decit iD p,,zilte
ia;;'ffi!il1;;;l
u,r rnrrnDrerc tDlcnofie sp-ro plfuIlni cstc $ezini;
mull
u$ujai.
II1 pozjlia,
.lTopall. dra,Eagmul .oboat i, jos, liild lraF do grourrtea
.lrP
o'rsaic
ror rniraahdonrioalF Ei asttet ptio.fuii *" aitore ,J.t-i""iil #,?^lij,
re6pualori a.^.psorii \.or puln destinde ftr mai traro
_As*,e iuii"
r oracrca. rn.r nrngcte ,lcnos
din m.n,l,role inller ioare .r 1 s1 9 gag, 6gbarrl.
6inal cirpulatia dlo uD Eurplus ile singc.
d,c rppaus csle o disptrec pcrrnancEid rare
atrlare illclu",_,!i:!!:,":
3rv
r11 lozrlia dc ortopnec. EtI se daloreste,
tie urui obstacol in ceilo
ue. aEem-cn' a, o

310

de regl'1rc rcoir:rli' fic rrh'; incrriici'D1e

rosnrrirlo i, tic lrrlburtrii
jl*te,ex t r'ema_
,.iriultut.,rii de o grr \
-i cr orarr di.l,rLo.i .leosebim
rir
ln raDorr rrr moalol de cPxfr(re
,r,.r,,l"ij
rii'.""i"i1"a 3i alspn6"'r icc;-'tentall*r",",
z:,,3. cir ri
'
".,i,
oi
-?::p ";": li:,:i!,i:ff,fll'l"x"Y'ill*''",';li'*
"a"'i'
broriic -' obcorm.roi "^',iio.
e
di"";*"i
llilil,,ii;'li':ii""#il;;;"it,
"ir
broDhroa,
BpasLi'e
l.l.iil;i;i;; .tiirin"ul', 1i sc d'a'LoreEr corlrtc('iei

i.i"ll.'"-:"

"i,?",ii,,;

;t

;TSl';-i11"3t":l'J;X:

""01"11i*,i",9,i,
pumonar
*atmrrlui cardis,c Ei edcmului
e setrr'ricur*rc Fr'inei'
acfr
;:-i;i'ii;"1*ki
tuLducrod o luLburlre
"'""'ii'i",i** o-anl;ld aparc nea'qLepl'al'parolo$ce
ecute c'rc prxcursil T ro' piocise
,,,,i''il';;;,,,,;; ilrcsptratoru'
ra : bronbopoeun'onie' pEeuxr-onrot
J"
,ll,l,'ii".i

il;::ijii;

"rirot

"^-o

ilr,"r',m:mtru1i$f*;pr,,E[$lt"?"",:#"TJ-T#
tn intoxicatii cu anumite substanle' (

*l,f ,*,f ,'**"q*hT{it#r{:d'flff !u,r,*${'i,

iiH.$l';,#

*i;t,,ry,.il;"1 "*rxsi*l
*il tif aparitia'
c.r'elrtuiu
ii

,',oaicainentelor ca

tft *1

obse-.'iln,:lH'J';'.,'.'"T?,li
liliii'1,'ria',;i.rr'i; ri;,;- din;o.'st ''oi.is,
Dorrr
leiplli[rct
l
ior a ale teolpemtltrd
rcmpern$i inrcsistm'rei varnriror
ir

],"5it"";;ilil
t

;il;;

"':isn'o'"'

rD corl'omto.

I rNslUNtA ARltRr^rA

clllttul' llsuprn_perptilor 'arleoa'reaf,'#'Jf

ri*tl ,-trsii-ruie tensi'rnes.':rrl'eritli'.-\':
a'slg[
PreoiuDea e!ercilal:i' rto sirgete.

+ortr, ale coltrsciae a

himii

(care

( ir

'1:i:iiii'ifl1#

'l"ii,^ff
1*i.u:H"a'l*,"-.*l;g-*#"ff ,'lm;,'lr'il"o''1"l"'l;;'H'
rea si,,gelDi
u.rcresiv de Ia roolr.,. la peri_
Tensiunea irteri'Ii scaile iu nto-G

11#flli"lt'i.l:
::*;'it#i:ltx#i:il"**'*gl;:t}"-fl
i;a"r"a a""onluuta se r"*"*

"*t;**"m;i; io primul rtocl de

vrloaxea lcNiunii ariertale fiin'l
iiiriii, e* "ariaze ln mod riziologic ia rapon

,"ft';Jt# ';,'ii;;

clr lazelc revoluliei cardi:lce. T(Ninn(,lr

flezinl,i Iril{]rr(}ir,
^rter'iili
i,ni llL.lt, iu .Ilriul siir,'1.r, prn.t.:rtiruri
,1.,.,irrril,rrra desil1r,.
'1.J
,\istoD,i llr Arh,,rnlf' \'jts(lllrr. ir,iIt, rri I'ollr1,e:izi r..j o,.xuriti't,.
(Ie singe pertc cel exjsient in r-ase. ,lceas[i tcrlsitrre
l)oxrth [u!ne](j
(le tensiuac sisloli(i sxu Drirrilui. ,l'ensiuDc& a.rteriali
\:a aIerl c.,r,
r,rri m'cri raloxra iIl cflrsIl ,lrx,tlolpi, ri lur(a ile currrr.rclie J ilirnir
'I
IiiD,] cUsenlrr !rosirrnpa \:r f; dct.. irL.lt.e.
uullrai ,lp a;t uxlizi,ro.,
,,r,crgiei lureu(iale dio pcrclii \,as.lor, caIr, erfltie et,,.lljtilaiii Ior.
\"r ciutr si-Si rel.iri lx cnliblrt tor,:rrt,.r.iol sirl,,t,i. IDlnicir rr
, rrrrr alirrlolc' ,, pflrlc ll si,rgclti dilr nrt.r,. tr.c.,. I.r;l ro si.temlrl
,,rtil:rr, vtll,,rilc,clo r ri jorrso ftlc l,{r.iI|r'ii nrt'1i|r]ts tc \oxr uhtinr.
l,t sftrqitut rlirqtoloj. cc..Hli I'resi||Dc poirrt.,r IluIlretc do Drcsiun,.
,li11qroli(i .xu rrilritni. E:r rre indi.:i r.zistcnlx po carc rret,irie sd ,,
rrr\ ingd i irna (lL,cxziu poDi|1lelioi \,eniricuitla, h car.e sc aclauc,r.
irr r inr pul qisr olci, Fro.iune! rozultol.i ilin tur(n dc coDt rarl ie a inimli_
. Etr.ricir le:r ti ,alil,tlll r:r.splor detcr.rnini rozirronlri pe rrre 0
!l1 inJill)IirLfl. riIls(lp l-r Il.rifulie, ar.irrtl un rol Lotrlritor. lrrrirrr.r v:rtrr
rrlur lenbinnii Ilr{,ri:rle. I'icrdcrcr el^slx.il, ii \.a"elor prj; dif(,t.jt,.
l,rooose patnl.rgir{,. iLtet,uIrxtoalr - dolu cre$ dr. si]uri tlinortLlc iI
pcrolii lor ctc. -. rru ( }czl|ltol urc.r.rL tcnRrulrii lraxirr,. li scrdorcrL
ton6ilrnii nliuiDn.
O vasodilat{fio g0ltctr t dctcr.n)iD.i saidorco l),,osiunij &,teriol(,.
cfikl
vaio.ulrRtri.lia, nrcor'o:r, ci. Din af(at ||rrrlii. ftrr.turii ctr.o rrhrl
I,o
in blrur e{ :rrodjlica culibrul artctelol {fxclorii ),rrIIj. ntnor.nli.
cDalocr'ini.ne rovegelatir'i otc.)!oi pr'oloqi fi t o'liJi(,tti,rI.rr.nriunii
r.tlcr'iaIc.A-rf{lt.nFiunrarutcrialil,t.itpt,ozc|lt:rIlrxlilicririirrrt,ortaIl(,
illlr-', R.rio,l,.^i(r.liuni ral(li:!c., \.:rsculiu.(., rr,Ixrlo,.)rrlo.r'jrri,. IcmrLl.,loui,0, ml]IuJ'qihirc etc., diD (.:u? ItoliI t :IilutrIi.il ti itur.Aislrfl
rrr. vfllorilot oi Finr olri&rtol'ii. rrtit l,IDtHr \lxl,ilir, n rtj;grL,,stjoului.
{'it $i l)cnttu rIrrflirirex rYolutici bolii.
Tohnica nxlfi rd,r,ii \'alo lor tcn8iunii:u.tcIirllc llebrrie si fii
(ulri'\.Iiii dp nriil.rLlrl. ttur'gixtJrrcll acrht,n|l in f,,, ir (lc trllrDer"rr, ,t l,ulmsrlui, la i,rtc, r'rrl', sLrlbilil,e (le rrr rti, , r artr. r 6ru.ci;t ei.
T,Diiuna;r rtrerirli l)oal. fi a.p|?, iat:t rlllt,i trn.illn(.e Irrlbul i

,:.'n,"l, lnlu rri.rl,

(legetclo jnalrx,

t'.llsintrexnttori:ll;1. ll, l rrrfl.:rst:r*.rorapli,r

llledir Si inclal de h rnirrr drcltltir t)c ll tcra rad_jali,
l:r nirrlrrl _.rntulIi 1,rr)srrlrrl. irr:' r t,,l i,, ir(l:, rl srj ,,;t,, ,, tozili,.
t,"rit.ri,i.I l :ra,nrr s^ \'I I \et..iix o Jn, \ x. rrr.'i r :rr,.:'.rrpri rrt,
r' i. I rillr ., irrl,ip,lic:, r,.tlI\||l ,i"{,.1"i rl,, I:r'lIrit,1i,. .111,{1.ntIr.
S{) r'r crict(ita x}oi cu irrloinl o prirniuue cr(silirrt:i asuila arterei,
t,i 'i r" |trI,l.L t,,rl':rtilr,list,a,. {1., s||], 'l.r:tl||l rr,orlrrr,,:rr, pr1p"s71.
Iorutc
lill r,tL()r. Prsilrer di.,it:rlli n iDdrrn]ui .\er.citatd iri
rnorlr(rrrinl dj{)ru ili(i nndei l)lllslliilc de snl) d(g(1u1hediu cchivaleaz[
312

xproxjrr)irii\'
lr1lialo.

(u l-nloar{l knsirn i nrlelialc do 11r nilelul

artet.ci

Ar..t 1,y.6",.1,.', rrc'r.siti o !\lterie|lli, inrl.l I|qalc din rriul,.r

,'\irrrrruillot rtII t .t r''r Ioa lr acr rt.:r apr.cr,ilr., :r r i rr.rni prrr, . ,,irtl
i\ n :
:r.e.l l nlit n Ftsr\rst,. ,l,r.it l,FUt t o ori,.or. A iuro\inILtirJ.
'lrr'
D, 14r.r0rDIrci r\rr, ti, Sriinliti.:,, :r ttsll.illoii ll rri:rto
r,,-Iato r:rr rr,r
| ,,rflrrl1 ,Ir.j.ll... ,tcn rito lolurrfl,..
sJilJ toua onar..
ii
rn I,rirrlr,r ,.UIcnrii. t ijsIr: .er tcnsi||llji xrleriale s" i.rtc (tur,,]
rrx,luil:r urlI., li. Lr io'.
^ii ,,i, rleterllrino ,lire(l rcrLriurrerr .irrr"irri
{liu artcli, so ll d(.lcrnrina
in nrod turdilc(t tona r*,i",iail pl=nti:ii
,1,"'Ir il,,rro:r
:r un.i lr{erc,
.r1,rul,hrx
!,,,,1,i,. ,,,.1,ii;1..,izii ;,;
\,r.,. ',.:r tonrllLrr rt r arlr.ri. I rndcr.rt"^,"
:r.r,..rrri icL,p :,, r.oml,rir :,
,rr u n.. ri.li,t,ll" rI: i.ri lrg:rr:i rl,. n rnanornft r segrr.cnrul i, .r,,
I'r{rlrr Ix Ii\rj l ri ri:, so rxcp,letatltriD.t.r,a, r,ioi,.cilisoel' corrrnl t
I',rl\:r(iilo nrrt'I(i .r,, ,uj, nir.,.trt c"rrrpr,.rici. is. ,r*iii"iiii,"i ,li,,,r
r1 pl,r t,rc.irrrx,ir djr) rr:ur.jcti. t,irui ro'al,turo nrir,,,, rrn,li piii",iiii,r.
t'r'hrr 'tt r\i.lenri ,I trrrrrI.ti rrr acrsl, rrlornrrit e, hiv:tltuzi trL r,r,.
.I rn, ir I
.li|l :u tr.r:, .oxrIrit|rnltr. \:tlurr.e.r r.i su r,rirrc
',r\ ,ri , .it)l..rlIi
rrli ln. IIrrIr|.r'IIIII
I.U,rt,rr cilrrrirrrt rrrlir+,tci.

.ll,..t."dt l;.;t,a.Io"ti. I)llt,ri -Ix,trrt:r Rivir-tto((i, dcrrll inkr(.ir

l,,rRIurLr
rl,.lirl'. sr fa,r. Ic rr[, t,xhnti,ri,,. At,alatul ts(c folrrrar
i,lrlllrlu r,rrDI.lii Irl,Irrl Ii(.{
tn cuI llli,,iu,o (u-o pclir, d(. (ruritl,,,
l.rrrnclLrtl tltt$.1'.i r.bl'. itr L.gljt t:i r.lr llD lIinoIl.ttrU Cu ll|(,l,clr1,
!r,',Ilirl I' U lr J00 II . "\I:r,rrrtIl r,st,. lltov:tzlll ,,rr o .[Durrli rerhlrili
tir I,iur ,t,.,.tn(jrx.lrrin,. h,.rrtl;trlttul ,k,act.,rl irrin;,,rni
'r',
1,n,rrr:rlxr.tx,:,l, ti c! ,1rirt. (firi. t.jt).
litrirI 'l,.rert iI.,r,.x t,.IniuIii : t,,trllo, l,ulrurul \,rr Ii asrzar
'rr tx,rili.. rll(:rt
irrr ur f.t,,tiu, r'o".u,ii,f,,-"i],i.ii,,i,,.
.iirr r{,.zirxtllol,tid:i
Ir,rrx'rr.rrrrI N. I'I'{iz,
s:ut pc Iri}I(rt liDgJ L ln:r\.
Ix.
:.,, lrx, r.z:i l,11rlul ,1,,]irLgrI ri roIret,rr rll,.rr"n"i,, .i*,
rrrln,n rrr,rLr"i,,

{r:,jrrunrll,ol,irl,..:.l,.ilts,.iltlntl(on,.r.irrrri,,r,i"tli;r,.,,,,,;i;;:
rr,.I ,1 r:rrrI IInit, rx. rrinxto rt Iatlx,:rzi l,It"It rarli:rl ,rl trotnr\.rrIr ili l:,:r1,la.ji llr.rntnll. t,,.iu ,,ri.,,;t,,,.eroll l,.r. I i ir, r U.."ti,
:r,r'rr.l,r
.r. rrrrrfli ii r1'DrJ,r irL i rrro,t I ir. Itxr Lr,1rrt, .tin c" rn ce'n,,,i
r rrlr. I'rrra
r1. nlrid. r.o||rpkt hIrx.r) l Irt(rei, riml dicn!rc 1,LrlAul_
rr|lr.:rc,-r lIohr,rt.
|rj|tto||tl \...triilului,se f,tce.lcconrm.irlt,rr.,.,,
:.,rrtrrr rli .;rlrr!tii.'l|In lrx,llx.It l ,.i ,l tro,,o
I,tirr,:r nrl, j,ul.:,tilJ
s-,.r,t'- rTri \.rl,,i',.r) l,rr,iior.tl lo pc ,,,ur,o,,,nrlirl
,l ,,r,:r;.;;r.; ;i;.,,;.;;
,r'rrr\.lttnrt .n lcIl"itrrrc:t t t\ilui_
-tlttu,lo ho,1,tl.a,r. I,atp:,rr:r I,||tsut||i perif,,r ic di\inn pu$il,itti
r rr,:,r .tr,.l,,r rr rtrrcr.rer l1o(cnlrr:rtI I rompre,.irrlii n:rter io.ric
: din
:'.r.rl rr,,ri\. ,,in r,rrtodr pn\)iloric sF oLlin vrtori t;,,.i;"rt;;rr;;;
.,.n,,I1,
r,rxr
,1".it ,., ilit^roi. Ko)otkor I intro,lrr" rru rr,du ru.irrlie-

alr. ,Jr.

- A!$at

Rira-Foc.i D.hrtu mlsur.E. l.nrn'ri' arl.rislc.

Ei0, ,16.
314

Stigmoteftlolon.

lori.-do ltuegistxro. r.nto aFigure prr.ceDer.ea nrult mri D,P.nn^ :,

nriqctrl ol putsxritc, d,".r imed;aI a,ipl lticti.r.i:",, r"-";"iii.i;,,::
lrxr fl nr.ccct.ea put |i utrde rle sing(.

Duptr aplicarc:r rrnlo(oi po bml.ul

_
&, nomn,.,,7,i ra.
rn .rrmonut DraL:ct'.i.pinj h disparilinbottravului.
pulsutut iua;if- ,ri,.i
r,,n(runoa roxtnxe. Se:rplicn uI rtr,loscop inxiliat
""ii"
sut, ;;;r.;in:;

r,u.r r(J.ll'a tr, maElclel, rt(.xsupt.& :lt.tcl.ci hllmerxle. (.it

tinrn nmsiirr,..
(trr ntxr\r,l:l este-supet.ioxrt trusiunii
sistolicc,tru
.n
io.ri ul"liiii
l trrrllrcn acuStrc deaEupli trtex]i cot.c{.late. p}in d(schiclorea
"u
sunjLn.i
rrrnn+'I! I prcumfttica. ircca8ta &] dccotnTlr.jmtr lcnt.
orooresiv_'nfJ
11. pr'+iuuca ei Bcndorrrcdiat 6ub yat.r*,i pi.sir;ii'ift,."iii"iiir,i'ii
Ir.r'st lhot(,Dt. .ihgol. dr, dexsuDt.o cor,rplimAr.ii a"rti",fn
r"",i,
I,'rr ',r iulontlr ti l,trt urdo itr part{tr rlidiilt a a.t"rci. pertillJ,ji,l,.
",i
,,rrrr..r r[ Irleltlor' .Lr.l,,rirl]i pri4
lrl.siurroa 6istoli r rrrrximl sl ,t".,;r, .
lrrr:U,.* lor lE tinrpul presiunii dinritolico minirn. ,H na+i"" i,, ,,"
r',r) urrnrc logat dc viblsliile poloiilor.
er.iali conrnr imaii A"si,ll,,,,
:ir:n.llr) rlo rrrnolrx.tr.rr, ill nrunlontul ciu,l
"rt so porcep_o pr.iniul iorL apr,..
r,rxr, r, p,1,zUlla vatoat(,ir teD6iunii rrrrrrime. pe
mtriuri ce so tour irLuJ,
,r,.or..pl'rr .ltec. loDl il,.dori[ din to iD
co
ntai
nlIternice. n.,ni,]rr
r:r, ril rl nrur poi dai tonul arlcriil
sil se tr.aasforrrio, conJoltrl'h,qilor
:r.nBltro al, lir.hidelo,., lnlt.-un 6uJlu. t-ontinuind'd;c;r;;i;".r.rl;_
Irrrrrur'a,.tcnate rcxpar, dar ar,um Sint mult mai
Duterliie. foalte
rrbrin{i. Dir
rnorneot, irtcniitafea tonuritor"
l9l-!f.'ll
"n''',
runrrirli..sr'acte b)l|s'..JFnhu cr
^cesl,
in srur.l, l,im1 s[ .li"parn toi:rl. pr.o6nr cir, oltr rrraD,?c(d. irucgisiraiC p. rn Eom;irll ln'moDrenlltl
cirid
loDur'uc. iltelilllo 6lrh,s. b rsr. i,.pr.ziDte rdolrrrx
jia.
f er"iunli
arolic. din alter il_
sin,plrficrrrr nli!urlrii l(rL,iunii artcri.rlc s-!u 0lil,,n.al
,.. -n,rLIrlt
(rrrf)rt{
:,},xl?lo
I r.:rnspor t n.bi l(,. ,\stjel cuDonqtom fonrrsfignrrrnrtnonr.tr.It $i Fligmot.,nsiofonnl
"rrlur
Inil,, llralon(.lrul cll mel.cur (Ble
rnrof )r ctr un r,rx olltfhU mcttli(._
x,h lrraqorx,tle.rUolalic{ au r':rrLuno cu gr.(datii drrLle: una
_, .lrloar'e
.l
iri
ro$ie. (i .e indic{ vslol.ic pr.tsiunca iu n.odtatea coloanci
,ro rrxlclui nr c..nh)til. rlo culoar.o Dr.ngttr,
car. i nrl ir.i .r.:tlorile prosiunir
ln,(l(.ul|ttoa (o1,,[nri (lc op6. L.!
ro
obi.q|luiehrt
se
1'.uol o l.DsiorrxI. ill greutate:! rrrlo:urr,.i
^;i dc'rr(rrjrrr.. c]tanorri,tr,.le
"xnrirn,
lncrallc:'I,i,.rd.rrIir,rlnrldiuelasl,ir.ilnl, kn..rtinr.rr.rrrrotir,laarLuirriro
Linr de fio reriJicato I,r.i'|.or,,pcr:rli,,,n nraDolrctrole
]ll*].l.l,lt,."1f
llo
Illrl.lll,. D. x(,r.x. utilizol.cfl trirrsiorrretr.i.lor,cu
Dir[omelt.u de
rrx'rcur' (8tc pl?f,.l Il'i1tr. Azi sp r.uDstrui.,r. oslf,,l .lc
aDcl.ate cu sistom
lxlrl'rl ltrrbii c rr. I'oi fi h,aDsp,n.tlltn f:l,rd ait sr: scut:gi tn..tcut.Ul din
rezol\:or, Barr .1in lrrb. rii lucre.rzi
lr..cis, ffu.tr srt Ecienite v.rificdri
315

lltlolld, oscilonclri.d. ('orrtn irr:u'(rl }togresi\':l

1lrieldr)r' ])rin

r,,,,rii:r I,rxrrr'.,rIi.n pro\or'.:r \il'rit,i .lir l,,rr,:r l,r,rrl,,r :,rr,rirri.

trrttrr,ir,,r," ,,,''.lor Il,r,rlir '.r";r, firrklk',i, :'r:,,lrrl ,l, ,ot,rl,rittrr,r,
si rslfcll(, siunile nlrrriinrir.\i nrilrinii Dol Ii (1,itr'rninril(, tlin 01)BdTiior r[ jrrs(,lir:r(r a(r]stoI vil)rl1ii, e\lriIrrLl. rtc:rcul nrilrrolltclr(rLrli

,.ir. ,;td. - ltis r$q liar\nn!ii arlerinle .! t.trthftnnrl.

rlol,rilio suir folr)ri, nnot osril:rlii.,1lrrr'Itrifu ulilizlri(! ln,nlrn inrl)_

gi$ln,alca os(ilaiiil([ at lcri,lle potui ii, lrulllelc d{} os( ilollrctre. Tiplll
aparate c"-l{r ostjl{rnelr l lh,thon (lig. 15?)' (oIrU)llB ditrtr'o
^tuB1or
rIAnlelii ]JnculrrrlIir'i, ['gatl do lln trr:rltollrlllll lrrrl lir'. r'r'lc xlnli]
r'onBirnL Drr'iiuncir dit' rrr'ns{'ii. l\l:llrolrrlrul .orrrlrni'i r'u lln Ir'_
2,,r1'or'. rlr itrtrriorD] cilrrix sc ri:i.$ nlc firlln rr rIrl'rrrli
tr)(r'c{i nlo
lrliri, iocilo Fub[iri si F.a ibili Ix oscilaliile.il de rrriri''upo calo l.-rr
perelii ai{{rlrti $i pc 44rc le rtuogillr'.ilztr I,r'in inlelnrodirrl
' \ocriir
llnri rc indicalot.. {'ir lil|rI lunreuDl m^nliplr'i est{j ln lPgtrlLDd cll
r)lanometnrl }li[,ezer1'orul nrinre, nloaliliciljle (le ])resillno deterrni_
Late tle schi;bhlilc do cirlibN rde nrtcl.ei se egaleazd, pri{ f{ptul
(;, schiDrbhile ten8ioDrlc intelescMi, [rtit, intel'ion cit Ei exteriolul
rdpbulei $i llqlfel DU ac jnilaleazi Diti,, rlifplcrrln de lrcsiuDc in{rt'
coie doud lirli ale ac.rAtci{. Daci inFX, lul'r.rrrrl rrr:r0tplei so sepuri
rlc r'czcr'r oi si nrano,r,clr'u lcu niulorul unui hnlon). riminiml ltr
roniaci numdi cu supr'afa1a intoliiri :r, c:rpRlll.i, rllrrlx i iorro.lr,odUi
,Arilr de !alori alc 0r'l.prei se rol lraDsrrrile.lir,,'t h,a?srrla, ccri'
la r'inalul ci lrjn actl indicatol le v:r inreg tttl slrb lol'I)ri de oscilatii.
316

Tehdca utiUzirtii p(:[tl ll deternri[rrea, tcnsiruii arter iale cu

,"r;lo eti t Pa"ho \lit. l;3) rsle 1,,1, coa a decuh,r,r ir,, ii l,roqrc
ir.. Se ipli.5 lnaD:ct:rI,|lc||r lirri I,o brrlirl bolnar rrjuiSi.nlomprzi
r'' ,.,' ar l pini oc se ollino o torsirr', srt'crio^rii rel,,ii t;rl supustdirr
. rl,,rn. In r,.cd rnollr,.nl, i||tfr,r Gt, ,.oIrJrl.,t in' l,i.i. ,.ir.Il3lin siI

,,in ,r/. -

(' lIi

irL

Oscitonrclrnt

t\rtotr.

\isrd rcApec{,iv oDrinalu-se. lrnalolc Booguine, l,o}inuto lr}

n lul hpr'c pcliferic dc (oDUrlo$iurlt,o tilalltet(,j, so loTeso

t,r,,l,:rg:Ll'

nur{inr:l Fupet.ioati a a{eal4ia., c4c:L co dtr, na$tcl.o ia lnici oscilalii

'le
rrrril(n r r,. nrrrDito Eupr'arnax DaJe. rlcr.6lo oscilatii pot fi DuBo lD. e;irlerr(rl Ir in itrt,hjdot,er .omunicaliei Dranrsolci cu }Fzel.rorul $i matrorr,r'tr'rrl lrrr rrjuto:ui bulonului), I)nDiela, te,nlinlnd in .onlrct dit,oct

rrrr i' I hrD)cntrl ioteriol, al capsuici.

$ ince])o rlrcon rpr'irrI}l a nr&nfotci pl.i,l de6chider{', ven{ilultri,
l,rlr[ .e lnl ditrnci din nraD$eli F(ado r b Direlul tcD6iunii )uaximo.
lr r,1nl rr',Ir(,nt. urda Fanguiui, sintolire dezuI)"tte pctelii nrlel,iali
.,,',r1,'irllxli ii pht rade ln arletil, confl ce di ruCtrr. unei mitcir.i
,'N, il.,l,'Itr, rl. o tDrlliludioe ntai Irrue decil, oscila(iile bupramaxi.
e

Ir,,.l Ironrenl, oAoilatiile Irxi nrftrj sa nlentin maadeparre,

lnl.ru,,l llrnlil \angui[tr sislolictr dpzlil)e$te pelelii arter.iali nrrmai
l,cnlru 1ir)rlnrl BjEtolei, penl,r[ ca i[ tilrpul iliastolei (ci]ril tensiufta
r,r.rl'.. lrirt

.o i

)r r I

x,

o BlDgo e,ric lrrai

mic*), lu menul a}teria,l Bi remhd mai departo

r{rrrl)rilnnl. I}in aleBchialer.ea bttonului sc lnisoa}i, cu matrometl'rll

tcrrriunorl din maDqeti, echi_r'alenti cu tensiulea, alin arter{.l'aloarea
317

tensiuDii din ,nansc{d. in morrlollt,ul riud amplitudiaea oscilatiilor

l.r.eqtc 50 moal brus;, Icpl?zinli raloar'oa lenBionii allcliale maxirnH
Continuitrd ilecomprim a man$erbei, rnltta sang:uind sistolici
desiindc ?eretji arteriau atin ce in ce rnai mnlt, albxal naftele la oscilaiii alin ce ir1 ce ai ample. ill tnome.ntul cinil presiuea alin manqtd
& ateYenit egalS ctr eea alin timpul diastoleit
'te)a isi r;capiti, cdibru I ei Dotmal ti llt
,li1Rlolit
miscdlile pereiilor
Deretilor alevin
delin
diastolS si
{i astJol miScd,r'ile
br'usc mar rcalue, cea ce Be lnlegiStr.eazI Ia zrcul ilicatol prin sciclerea bruscA a
rmplitudinii oscilaiiilor. Prin descltiilerea
butolului se ya misrlla lr'esiutrea alirln]aE_
$el; in aast, momnt, cal'e e.hivaleazd,
in prcsiunea inbairtprialh di]t ljmpu]
diastolei, ailicd, cu tnsiunea minimi,. Va_
loarca te[siunii alin manfcti, in momentDlciral amplitualitrea oscilaliilor scadc
brusr, r?prezinld, ya loar'ea letrsiunij mini.
rne, atiastolice.

Beilucind mai aleparto plesiunea diD

llrifisel.d. sDl, niYelol leDsiunii tnilrirre,
Iot rnai'consl,ato pr'ezenla uDor os.ilrlii
dolemrin l,e ale expoosiuffa,sislolici obilnuiti, a leretrilol arte ali. Acste o8cilalii
poar't5 Dnlxele ile iDi amiBimale.
Scsizlrea nl'ccisd a mom,nlulrli culd
osnila,liile snp ,me:imate Rc llrtr"lormi5n
oFcila,tiil tensiunii maximalc, prcrum 3i a
rronnntrlloi clnd oscil,Liile tensirrnii dic_
stolice Be transformfl ln oscil,t! ii iD-6 arninimaIe, esle.lificili.i
cere o experierltx indcluDgatd. DiD acest motiv se preconizeazh uti
Iizarea a aloud, r'ezewoare de aer i1 manqeta pDeumaticl, a?licate uue
peste alta sub forma tiglelor ate pe acoIeri$. RezerYolul proximal al
manqeljei amortizeazi, oscilrtiilc stpramaximale, care astfel nu rol
nlai aleranja yalialiile ile ple$iulle aho manteta a aloult
O8cilometrIe cotrstidte ilupl principid alalatului Pachou sint
alestul ale oumeroase. Amiatim oscilometnt UskoY $i oBcilotonometNl
ReklinghauBen. Oscilometn RazumoY lrrnctioDazd cu uI\ mano'
netru cu alcool Ei dx posibilitatea rr[or determiairi Ioarte precin.
Osoilometr'ele pot fi utilizat+ qi pentlu 8ta' tirea lermeabjlititii
arterelor la exti emitdti.

l.ir. ,i3. - Scn.ma oscilometrnlLri P.cton.

318

Peutlu misluarea oscilatiilol arteliile de o amplitualll1c mrnir',xld. cc dc erelnDlu rn slfuile de hipotc$iune co]llrolatd. s^ nli]iplech onice.
zcazd, oscjlomclre ipcciale, lcgato dc arrr!lilicaloale
cxisle apal a I'
ir'Ip
fentru iru'csish ar'en .oDi iooe! a lenhiudi al let
gr'aJic curbi
ilt.cl
iu
dixil'c
acestea
Orcle
spccial construil"o (fig. l;9).

rrir, ,r'0, - Alarat pntn' ltrieg$liarc. .ontinln a t

Dsiuntl srterle)e.

\ ir iatiilol temion.lle 1Bl,r.o unilRtc rlc ti6p. .^lte lipuli ate apalilo
iDscritr 8ub folrna unei corbe .otrl inre teDsiuopa lrtcriald m.dic 1,"
un kimogral ob\nuit. lUanqeta acestol apalate eBte cordectiolati,
diDtr'un Drterial absolut inextensibil, cal.c sc Druleaza ?erfect tr)e
pantea distalti & alrtbr'atului. trIa.n$eta este plitr, ou liehid, care
tlans dte uLlele sistolice ale lulBului radial unei memblatre de
cauciuc. Pe acea8td, mcmbrami, cste lixatl o }icsd intermeallari
care, preluiral oscilatiile membra,nei alctelmitrate dc rarialii1c tcnsio]1a,le ale lichidului dfu ma,n{etd, pemit scdpare& unui jet conBtant
,le a,er compr'imal, ln tuI)cl ie do oscilaiiils membra,trpi pc.are eRte
liral. Asrlcl se clccazd dilerent de pleBitrIlo lo intcr'ior'ul a,pal'atu-lui.
care pot fi trsdis cu ajutorrl unui tambm special pe un kimogra,t.
319

ll{is1:i li aprr[Ito l]nle ful(tioncazil liriL rnNn,,sote. Artslca irr

rhrln (tn}itr1r'r. ti nurtlitu(lirx r pllliu

r.cgishctt.zii i:(,nsiurcr nrc(lio

Iui Iadilrl.

I( tbndrtle.l&{r i.p ilrr(,gislr ri ox(, firn('1il)ncxzir r\i lx (liN1rIt1n,

Ir}1icu ri)arl11 ll1i (1uo fa(o ilrs(l'i(,r(,r grrijiril .t letlsirrnii,
1,r (liBtruliI do lxnutr-.
Ii
rfczrttii
1)orlo
]\11i, iil)nri {(} rl)rra1o iruogislr.eaz:i r irliilo lcrrsillrlii .rl1r'r irll
ir

FrlDsul {.ir

1x r.rrL, to1ogllrtitri, rBcrrri-rriiloruo olecttoca1(liogl Jflo],. r\(cstij ,rl)u-

)ito. rlortrnrllc.irolar!/,,r/rr'.1 frto{ior!-rlz[ cu {) (ic]rrl:i ft)l orle(,Ili(ri

Orirar{.rri li r!)ill[l]nl $l1r lrlo{odrL ltliliz1rlir lxirLlI rr rrriisLu'i['(rL
tonsillnii rulerirrlo (rt(, l)iirc sii ro l inir, sc:rnrr (lc ,flurlit(i logu]i pl1rr
1ir1 (,1(,rnrn1xr'ri lxr(rn i.viln uuelo rtori dc liu(gislr':tir'( .
11,,r., r,r r:, l, l! *,rrr rrrih, ,lc I'rilul l,,lI:,rll]ri, irJ.r;rrr,rl.i |tt
I'I'r:...rr.ll,ri,,:,r:i lit,.ili|l.,l.,.li,il;,r,, 1i fir;,r:ilrirr rrr ,'.rtrrr':rrrr, l,.
rLncl(dor c\lcrioxro. l)r(ii r!)li(ur(r! lrrl[!i(l('i so IIi(r Lrr, rl(orlsln n]r
no rr nrxlrL! bitrc pc BUlnrrfnli l[Nl tni li lcrNirrlrort rl;n rrrtl.n|{lri
nn 1,1r ri,fl,(,ir I.nsirni.lr nrli{{ irlli.
.

)lr[n1,rl(,(rul sc p]rscrzri IL rLirolul ar'iole,ir rlflulnrt (iircirl sc frr.e

rl(,1(rrnirr,r(,n tcrrNhrrrii. l)rci so lrliliz(,llzii urL rwrllolrx!1r'rt (xI llrer.llr',
s(' vir \ o,r glijii clr dif iziunou 0 x I lrbtllrri lrrrrrrontci,] ic sir, Ji(' lir nirIhrl
rrlr|x,i. llolrrvul 1r'ol)rrill iolrlI,rlun11 1l$1fl,1 Ilfonlt, lncil Ilr'{or:l irL
rtlnzi[ s:i li(,]1l 1,iiltill(,1r irrillrii.
l)( l( lrlrirxlr(l 1(,1rFiIrrii ut1(,tirlI(. fl(r r:r tir(o {(,1(l('rlnn irl ]1}rllls.
liolrorul oLrosii, ruloliiorult srrlr iu liruI)uI ullui (rlin tr l'izi(f ln'lfzirtlri
1r)l(l(,Iurul lrorlificirr'i lrr)siornI,; dir] 1r(]{''iii rtro{iv, rnriirullrcu ltrNi
Iuii ruI(rriu1('ir'(,I)rri0 Bir Jic ln(,('(,(llllii lolrli]llrrru rl{'lilrittir(rr lrt)lnLr'
\rlri. .l)jI t((hii nr,liv 1r'olnti('ctilrlii r'ri (lisrrrllr]{'N rrrlorilot l.erLsir,rrrl(j ol)linu1c.
\'alt)r'il0 lonsiurrii rll'iuirrlo in pritnolo rrrorrrf]LIo rlrtlril rrIlicrrtr'rr
rr,llrsi.l,,i Nitlii llrx,(ni rilIi (r'cscnl,t (l.fil LI rrrisruiltor'il('lrlltrir,rrrr,
rltfu ir io (lrlolclrlorcrl(,1ilrilsihicc (lo(lan!tr1,ii d.o (orn])rirrrrr'( rr l)rrr
llllui. l)c lr((\,rr rHlo 1t{rc( Bilt clr in {tz alc snsl)i('ir I{r $ir, r'(iI0liurr(hnrr:r_
sru'lr'(,i (e\rlI1UIl (lc rr1li rllrlllc ori), {iuri $[ rcoxl{'rrr rrrx)Irqolt
l{'
l)Int,rrl br)lr)ryuLri, drcor)rt)r irrirr(l nllI)riri lnirtrrl irI inl('r !-trldc (1ilrtI(,
rritsn) [l ori. I )r(,ii 1r loli]r: oLli[ll1o Yol li dit('l il(i, s(, Y11 linc serrrrrN (l(,
(,(,1' o1,1irLulo Lr nltirn1r (lctr]'rrrinN](.
in urreL: (rzrLli, \rrloIilo lcllsio tl{! lxri li (liflrii,(i 1rr, r,l1o tIrrit
rr, r,,hr,. rrt,.ri,,xr| i r l', ori .\i.l.l u ,lil'r' lrlil I,c.l. lin'il:r ii7i,,l,'!i,ji
rlc 1cr.i,ir,r rr r.rrr:,r:r t:r r,,.r1,r'.1,..,rl"ri,,rr, ir{i d,,,1.,,i, 1.,
rro[]brele iruerioxle. -\(,.,rsti dil(,(Ilir lerr"ioutrli, so dxioro$1ij lrn.i
s lcri :, ,ir,rl:,(ici :,rr,rirl, ,l, l., rri\', lrrl r,r.rnl'rulrri rriPrlri'. in
rrrrr rr ,rl,lirnrrrii ; r 1
' . r r r l,,r.,l, r lrrrrr, rrrrlrri rrLrri r:rc. l)i'r:'r' 'r
,

'

jl20

'

i\ . ,lul,., rl'lir':'l iilc rrtpd i.ulu i. rp for f:rcp rndrur Sl 'tri corrrpirrr I i\.c
.,,i'1. rrrr; ori ,e iscste tr. o iust'i''run. in a..Fl soos.
(olnJnpi
\'.,1',r rlc lotu\irrrrii :,r rcriile .F rJporreiza l|r srurrl'alcrL
sxrl
rrril;lrrclr'i
.\l,rirr,rrlc
in
,lrrr
rrrauolrrolrrr
,1,, rr,r' rrf
'colrn'tlIr'
i,'r,,.if,, nr.r,n,,r" I't'ir r,,"1.'d:i :rrrqcrrlr Jlulie h rtlrrllrrl nAn'lrrs rn
l'cnlrrl
sl"r,,,l, r',ti:rrrs lizi.:i p'ilrir. t:rri:rzi ro'ro Ili {i l{urIrrrHgI'rrlrrrrri'
t, r,ilIll.:' ri,x\irrri si inlrP ;i 'i C0 rr.rr,Hg l''trlrrr lPnnrrrrrP:r
(le ten)}errt'
YNlo) il{' tensiurii alteriale se integistr.cazl in foaia
rrrxrginii.:rrl)
lungnl
d,
il.
.uln
rrt'ri,
r,zeir:rro
in
rrr|'li ,' bolnarrrlrri
h.riuare,r foii; ilrrrx fo.tirt dY IHrr'I'rxlrrri Irrr rrrc tul'rx'r snecrrrn
ilrrl,n
i,.,,rii' r"""i,,,,-- :,rrcrirtn, no,,,rcti r':.lorilo, .n r,r spccitica
rrrx\itrri
rllorilP
I.n-ion:llo
rrr'n,,ro
rlp
.'i
RR,
,lir
irr.n'1"
iili,, n,,"il
rrininri, de exonrDlu: RR : 125i80 rnmltg.
(f serul, f_irslr'
Ni!.lul t{'nsiunii rul('li,rl(r vuitzd in l.rrport
('ulsul
zilci'
t)ro(1rnr tj cu ornrul ,r(tirititii ti2iologicc in
1ni,r

.\stfel:

ritl". l.n'i..'r' '^l'1i.1 v tra/i lr'lr'' 'i 'i q'r ri'

nrnrlr'r
r', i,.,",1
t,r..:.ilrJ,l,ri.li,':l !urr-7'l lrrtr( : { 'nnrllts
- \rrln.!Frirn'x
' i' 1.,',il'rR"- t(r''I'nn,
\n .'/i lr'lh { Ilr' "r"lir
,,,,,i,,t.", r-"-*",1"'.lut(l\r.i,r7r "'ln'" !r' i ii ruJrII'r
I'i'\: I2't n'n'lta
,,, ,,it^,ra, r",.,",o ('...1.ri rx izi lr'r''

i',n.rr" r.,*u..,,1'.Ftnlir'1 t{rnzi , rn'ii ri;:' r"' llx

''t, ir,rt
r.^-*., \i\t,,l'rl v 'ir7:r'nI'r IIj' 'i Il" n'rnll.l
la arrutii to,siurta diarlnid uriszn ln(ro 75 si lri) nrnrlls
:", '1, Jr'r rrn$ '( ' 'in'lrrI ai',' r" l rrr" lx Ii' "'hllr
'n'nt
,,,, rrn!' 1rl ri,.\,iirR i tr:.,rrr l)rn1 lr lt" n'u'lt(
i"-" :,,,t.
llln',xrlrr'ea rtrlnrlrlhli ,linlR lutl'irurcrr lrrir\irrri ni lrrinirrre t '1"'
lPrrsxrn'ru ir\l"ll',
rl, rrs, rrr,.ni:r, 11111, rrrr1r1trrlrll). l,ifel(n1:r rlinlr0
(lifcletrtial}'
,ri r.t*r aiutoinl }orrrt?i rtunlelo {Le 1t)nl{irlnc
I., f,rrr'i. lcnsirrrx r|,rr.ri,rl, ('l, in gonnlrrl eorn t"i'i " i'I (trr
:, lll rrnrlllr rl',..it Ir l'rrl',,1i.,'rl ''\,1ltlrr l(rion'lci I'rrl'fllairr'
Ni\.clul lonsinnii .,rrPrirrl. \':rrirzi:i in IUtsrrl rrrlci:tri zil"'
r,r, Totrl xr(t o{ilxlri {le lu .lo rrrlrrlljl \', irrliile zilnicr'sinl rn lr''
.l"ii'i,l , xr",t,,i tl. ,L.'rivir:,rF rr urs:rni{rrrrrlrri +i ' rr rorrrperxrurrr
rrr
r',.lirrl'ri', "rrrl'iatrt. 'Itsnrirrrrox '" J rrr:ri 'ul'r'rilit sts g[rPtrp
r
x'r'
xlc"re"er!
srnr
ne
\.rl"ril*
lir,',rl s,r'ILulrri trirrrinir(:r.
*",,r. T.n'i'rrr,,, xrrorirl:r 'e rrlri in t'rrr'{rtl"'xr
,'i,iilii.r,
'lotrrrri'
",:.r',.
l,,r 1i,,i,1. ,l'rr;ri rrcic:rl'rrrr!l.nr,. 1'rocrrrrr ,;i irl trrrul axol'iilur' \iloril,. r"rrq,:i,rl, xint rrJl'r, rrl lo rt ,lo r.rrrlrorxtrrr, rrra'lirrlni in'oDlrr,
IiroI'. irr tirrrrrrrl :nlitiretii. rrr ,crtr're rrrprrrincilzile x r ru crrr{ur
Ttl.lor .nl.huoxsd ttn.irrrre:, :rrlPriila nrtlr" t:r t'ig' 'lirrrfoir'rra'
ii.i",:1,,':^*.oo.rri, titsr g.n"r:,lizJl,. l.nrirrncr .trlrr.i;rlr, crtsEie
(;ridDLle urcltr'e a lcrr{irrnii rrli ri.rl. ilL r|osle stilr nu deprode nutrrcr
311

factorilor catzali, ci li de $'.rdul do lcx(tivi1xl.,,

olgadsmnhi, care determiri vm irtii irdiri(lur1e.
Valialiile liziologice ale t.[si[trii alte] ialc i[ cnlsul zilei ntr
depig.sp 20. r'rx\irnurn 30 mn.lle.,i,r ri rc,!Ic nr,,Lidi,eri r',lar;r
mi,i pol xr,c o h',mnifi.rli. l,rruloti,5..F', ce r'ccl,.rni itucgiilr.,.
rea sistematicd Ei coD$tiiD.ioasii, a tcnsiunii arteliale.
Niyolul tcnBiunii artcfiilc j)oatr, sd ricli$cflscii.raILI'jle riormalo irr
l,lu-, rrDd vorL,inr d. lriL,.rrou.iurl,.. .ir ir, rr'irru., ciuil \,,rbin, de l,i
Iodili.iril, ,iI flu. .JI rr rn:n ., potnii irrtr'rosoze,:r'
I,on.iuI.x
'ltsDciuDc,
miuirri. ctl .r r.r..iur ,:' InJ\ir_nj. ln a.p.le,.r/uri. 1.,rr i
ll'lpa Llil,,rc0!ialii r;r,rirr,, , , I l . I :l . I I i11,. , fl7Uri. ir,.ii, rrir.,
1iile i,eNiunii mnime F nririlnc rnr sc fxo lar[Icl, ccca (o dci,olnrir]r-r,
rnorlificflrea l:(,uirnii dilcr'cnlirlc, r'cillizir{l 1,rl)iorlilc r1(! hit,(,r1( ll
siuLre ]nrxilni, hipotensiflDe rrrlrirr)il, l)iIr,rlrrAirtro r)rirrirlli fi Liti.
l frsnrn(! minim:i,.
Ililx,rt(,lsirrlloir r,1t{r'ifllii aptu'ri (,1 rr sirrJrlorr ir I!,li1r \rsII
lrrr'c, rrlo rinichil(n, iI tiull)11Iirj curlorTir)c, rul,r,,l)rIzr'i. lilx,rr,)rli
cisrrr, lrcala llr,sodoN, iDtoxi(olia srlnlrilriidio. srrrl rorsiiiuio () lrrIlll
i rdcl(,Jldrrrtil, boala, lriporteDsivti.
Ifipolcnsiutoa a icriuli tlparo o (ll1ii (,Lr s.i(lrr(rr for'1oi ,l('
contrnclic a ir[rnii (nriocru ditc, ondc,(,rr](li1(', afo{,titlDi 1 r1rltl:r}o si,Lhilizal,e) :Ilx)i ln c0z do insirli(,ietrtli (,ir1\rllttrolic lclji(r'i(:j. l)rir r,,
loxaro'l, lololilot vnsculari (ca fir rr r)(liltlllltia I'rlrlili(,li r l)olili)r
jnfectioaso), in (,[z ale r'filllcor'0i rncs{!j vrngnino (]rcrr)r'rltii, (lixru,.
1'rlrait,ur'i fl,occDtulLt(,, lrlllllnlilr,iii Nbur(loxlo o1(,.), l)r!,lllr fi urx,lt
i,ulLuriri ondocrinc (ilc (,\clnphr insnli(,ien1 gllnrliloI snl,rrlirlrltf).
\rari,[tijlo itlalclutdcnlc a]o l,e)rsi nji lllllxirrrf fi rririrro lx)l rrro
urr sen! divogeilt }rin cre$lrorclt tcnrjuDji nrnriir)r(, rlr sr.ii{l(rt}l ((,ll(nnitenlltr a lionsjunji nljninrc, slrn de scDs con.l(n'Ar,r1 .l,r'ir s(1id(l]plr,
tcnsi[nii lraxinle fi cre8terea ror{,omi1iclr1ii N {{rloi r')irirxr, XIo(lifictrca divcrAenti, a tensi[nii mflxi]nc si milrinlc s(f i)l,s(,ryri ill oaz do
iDslficiertl aorticii, boala .llascdou, onerrji a(c(,n1nrr1(, ti sclerozr
l.trlelor ma . llodificltilel, convelgent{ se c(nls1|t[ ir slenoza n1i('le inteDsitatea

11

r r ,

, ,

trali.

D UREZA

I)i[rczfl ;re sco]nl ale a elirnina din orgNnisxr iul)itantelo iirr

tile prorenite din metabolisnul intemledial ])roliidi(. (,xre acurnnlirlc
iu Bingc dovir toxico pentru organisnl. ],liminalca :lcestor sDbstrrlr.
se face in solulie aloasi Si impreuni, cu ele phSsesc orgaxjsnnrl ti
sdrurile millerale, Drecum li o serie ale alte Bubstanle de dezasinilrlirl
de cale olganismul nu mai are nevoj,
322

lk nlrll 1r sc t)utorr oljeril asuln:t )'rllrolltlhi dintr'u ctnl.ilirtcr

r .irn orrisri irl cursul zile; ii (,e, ilnt (lrlsul roplii, so ya lecoliill

de
st).

{,rni'ii nrhlr or'(dc 8 {j:1 rsi (c1r .lilrrirrtrl,ii i 1t'( .rr'(re 21 {i

s ,lirrirelr(r runritorne. LN rljrtl}lliici, i)errtln rirrrr:i.rirex atinilrrjcal lt
i,'l( r'r rr(ci h1:i (le hi(L atii dc cNrhorr, ur irt l olr lji din 2i (1. ol.e so \'rI
rr)l(rllI rot)Nlirl i]r ti(ii (r,!ontrd jrr rrfi rmlt(]) llrlNtlc, rh}X in n,iflrl rx solor' {lorLsrrrrrrrtc (tc l)olurr.
,\sislorrlx \n (rlucN 1)olrxrrul rii ltr;nIzc rrrrrrrrriirr nrin,rl ,ti sii nlr
llIrr(, rrrinx. l)dcrrrinrrell farrljlntii d(, uliruj rrn llo 1)orrt{, {.rc(. }xr
I'irzllr)t)(n,icrii lxrlnaruhri. ln)lrurrrl irrr)l)ilizrrl lx ptrl !ll, Ii inriii:rt
(l intrirlic rlo rlcli,(.rrc rtir rri g(,loxs(',1 r{'zi(ia rrlinlrr'i, lnrntnr x ru o1irrilll u,irL;i nr plov,ri, c(,.rr (!' rr irii)icrln,ll. r]dtIrrrirrnr(]lr ('\ir(ln rr (ij.
lrrillll InriNir (l(, l)olrLrrri ir Irnlirl( \,ri fi coIr'laiii irr rIs| r,ilirt
(lri(r,. l.{rrl1rir, (I gi1 hrg. ('uri1i1o rigllros ti l,ir( Nci)tx'r'iit. \rs(lo
\rr'{i i,imrlo l(n(lrrurrr lr }Ii(onrr. ixirlr'rr tr i)r1'vorri {lcr(orrrl)rrrr(r'i)rr
,r)irii in iirrtnrl col('(,i:1,ii. l\,lllrn x i,,rt,i(!ln'ir t)r(x'oso1o,l('1(rrlxlrr
1,r1i(, sr'\,(,r 1,(liusll h urir,r ,r,l((,i,rlir (ilovr (riilrL, (L( 1irrri,l ((xr(i
rlll rr{nlifi(11 r'caf(iil'r'hitlli(r,). l)r{,|i rn ir\'(,rr lN rlist),,zi1i(] !ll,tc gr'rt,hl( rl( lr lrrb}i|il rorrr t)ri(,r fllilizrr olnlc lxrrr,rrtt (l(i L] I I(s' lxl
dr|r, I rorrr glarlrr rroi lxl l,rzir rriiNllriil(,iiIrr:rnlorioru(' crr rrr)
(.rcior rl(nrxlr)Srrl, s:Ur {,I lx.rzi rl( l(lIt()1rl|rsl. lil)i1{, voltilrrl l)rl
li tr, {,rr(, s(, r)i)1{,rlzri ( lr {x'rncrrlii rrirchrril(, (ortrsl)rlnrrilor)r'if
"ti(i,
\olurr'l(,r Iixc (l(, llririi. SIi(lcl( l11,lri(i cii(lr(i,ric, Irrlir)tl r)rrrrr(l('
lrolrrvrlri, rrrrrrrirrrl ,'rrtrrttr( i .qi NI lrrlllltti.
llrllrt r uc l,rrl(ir (lrr sullrlrrr (l(, {,ir'('ulN(irt li('Ii(11,Ir'(lirI orgtrllisrlr
lsl{: n(,(!'srr (|N, nlilU,i rlif irrl'$islru1,I \'()hIrrrIrIrri (lirrrorci, s11 st,
rrolifrtt oxn(i \ii r,rlrlilnlilt rl1. 1i(,hi(lo illgorr1(i. Ilin ]i(tri(1, irrs(rrtri(l
s. irrl(itg(. i.ol ('coI r'(,r l)r"rrrl l)olIHrul:,rt)lt, ullli, ('r ! , sqr11, six)l)
,,1r'., lir l,lrr'o s(i ri,I rrlirrsti rqi lirhirl(r(] t)ro!(,nilc (liu zrr|zrrvrtlrtlilc li
I I
I {lo li(1hi{lo irrglirtrl(r
l'11r,1clo r,oI\rrrNlo. lltllxrlrl (lirrix)
(,llJrlilri(,r
I'ilrrlIl
rftl('(,1ri
rn(iuh1n'i
ltnri in rng|,niirrr.
olirrlnrlriii
fi
.\,r,sl 11r:]n,r1 Iiir{l it'hl{lxlrii si (l(i 0 sorj( rlo Illi ir(io}i ca: rr1liroir
l,i((.hirIlnlii 1r r ir)xrrlol('r' (onsrIlll,rlr, ,Ir t)i(r'(lrliI 1)rin Jx'rs])ilr(it)
:i t)rir sr,rIn c1r., r)i1c Liro ra lrurtlt'l t'u rlel('r'r)r ilrrIr'(],r (1Inli1i(ilr)r
,lf llrirrr'i irrriBo.!i (I) lichirlr lon,surnlo sr'l so irriri {i grrlitrrl o\'olulioi
{r,rlU ii i(n t)olal(,, t)r'ir cintih ilclt zih)i(:1 :r boln:rvulli.
r.rlrriiI:r1(,rr rlo uriui crrisii 1n 2l (lc orc slj nol(i:rzl-! zilnil, po loxix
(lc lcrrt)rl.liurri l Lolrr!rrhi 1tig. l(j0). Nolitir'oa so lrrc{ Irin hxfrr
r':rr'0r t)i{r'ri1(l(tol colr, tprlxz:it{){r(! .rlntililtilor do ulini fi zilclor r'osEroa*i
Itr{livri. Ilr,\ru' 'er tso fr('{r (xr {x(iio1r rllhastr,lt. Ni\dul linici ,,riz,,u
r. l^ir,1,. r, r,rl'.r.,llrJ ,.or,.l'urril, ,r II'l, urirrl. Ii,.:,r, lrri'
':,Li Ir t'1 ,. ..|lr |n rrjrr,,, hi\.,l|n,l , r 100 x. ln :,,err iil. 'li"r,,n(rr
ruJrctrti l)e oldolr:l{., foii rle t(rn}elNlnlii ])eutlu I grad de tern])cla_

Iirrri ulirr

r ' t

III1

( | |

:t25

3
B

cchira,IeazS cu ;00 rD1 de i 5. l![ot ]'ea diuzei 8 face totdcruDa alimileaia, pentru a, cuprirtle atit urina emisd in timpul zilei
pe cea dil1 tim]nl noptrii.
cit si
'C,[titatea
de urili olimiuatd in 24 ale ole este ale aplorimativ
1.i00 1: La brlbali, canl ital,ea pstr c{'va mai mar'e, 1,200-1,800 I,
iar la feDrei cpra Drailuic6, 1,o00- 1,400 l. lElt ucrl ToluIDul urinii eslc
ir fnnctie, pe cle opartc, ale cantitdtile de lichide ingerate, ial' pe ile
elte parte, dc l.arljtrlile de lichidc piIdul pc calc exlraurirMrd,
lrran.pi]alii, Ecrutr, erapotlr.re, pth pjamini). rolumul urinii poate
.rria Bi tn coDdilii xorDale inbe limiie foar{e I}lari (500-3 000 m],).
Exclptia de rx jDe .rptlp tD.molii sau sub iEtlo.Dla tt igtlrri. Din]po||rvi r'eqimul se.r muD.& rizicr' itrlsotili de lrrDbpirclii abunalenic
r,.rd ir'ei?rtor'tolrrmrrl utinri. ANlt,l de ratialii, ot ir'il de mari cr Ji,
(1tcd nu recuno8c alte (anze se intadr'azi lD limite Iiziologice Si nu
irl dci o semnifi(atio patologici.
l o, ;o!iilc polatagice alc liltr,:'i. In rourli!'i !arologi.ts,px.rc1in
nr in ji Iloa ie Ii mtrt ile Ia pc6tc 3 000 ml ritrd rorbim de poJirrr ic. m iniora'A sub'l 000 nl, ciDd rorbilrr tle oliSulic sau !or1e fi .omplPL
. prjmal5, clnd \ o, bim de xDtrr ip. Anor ir, eslo lotd, auDa pa loloe ic5.
rD schimb poliu ja ri oligl}r ia pol. fi coDsideral ca scmne patologice
r rrr mai daci se pr oduc lD lipsa latlo, ilor' fiziologiri il. nrdr i]'e iau r'edu_
poatc tntimp)a ca, o poliur ip liziologir5 s;
'., rp a e:cretiei. Astlel sc
rip de uD volDm Drai ma:re dpdl, o poliorie Ialologi.d 8au oliguria
iiz:ologi'.d EU Jio de utr Tolum mai rnic decll, oligllria pal ologi.a. Poliur jilc ei oligrx iile Jiziologice rinl toldeauru, t?citoarc.
ri) ? o ri ? ri a sulvetriti, in st&i patoloeice poate fi tlecd,toale
srn rlirlabiln. '
p Poliulia tiecdtoare se conatatl tn Stati]e telrninale ale perioa,li lol dc oliAUl ;c, iEd prir1 illcelar'ca raozei c5,,'e a dclcrnthflt r'elentia
'
dc iirbidc in orgaDisDr se prodnrc o poliulie. JD acpble cazulj. poliL]_
r i0 ou ar. ni. i o cemdficalie pr{ologiri, Si ln rra}ilate sp incadr'eazd
p, iorr'e poliur ijlc fjzjologiec. r'h"i r inicbiul indcptitrpste a(um o tun-.ljc
pp i.arc mri rnainre. din motire xlrarellalc, Du a pulul-o lndeplini.

turii

,{stfel, loljurja tre([toare apare :

in perioada de ttlrrscertd a, ntror' boli ilrfeclioa8e, ca:
'plenmonia, ]epatita epitlenic{, malan'ia, e,tc, A.rasti, poliuie poai'tr,
xnmele de loliurie rriti(d 6au crizl lrritrarB;
cr.ize alo colici }enale, occese ale ,ngini, pe0toral6, de
- alupdiBter
ie ;
epilelsie
Fi
ln perioaala de compeDsane a stdrdor ale insulicientrS, c cula"

tolie;-

- in pelioacla ile rcsolbtie a ealemelor,

t'ra,trEBBalatelot

qi exsu'

t'oliruir rlllrlrlili Btu lx'r'ur,rnexlii apnrc in caz (k :

S, lcrozr r.n|-l, ri rl,{.I,,r,..,rrrqr rnril,rirti,,rrr,l rirri,trirrt
.
ir-x t,k.r'lrrl '.:,1'rcrlul,., ,1,.(r,r..,.nlrJr. .i r.ri,.l. 1,. r,I I.tir,rilL,r,.:
l)rodllsclor'{lo d{,zrrsinrihtjtr [j I rimlilo| rlliIeIrLlc iu exccs. osl c nt,r.r,.. .n

,, Irl1r n.. l' ,I rilltr. dr, .,,1!,Ir. lI :I",rr. .r 7[ri. ..irr]l irl.I r .ij
lirJIr,rJ lr1.irrr.:1 I ri l.r .i ri Ii,ri iI ..1I r1,...r,.i
in rlitll)ctul zN]rirrrl fi iIrl\itidr (,irL(l t)oliur ir se (Lrlor.(ntc rrrn)r
,:,Ia, l,i,rr,,'rr.], r l,r r,r;r,rrl ,;rz.,.1:r, i,r,r,., ,:,r.r; Jtjti,r rr:rrr,tr -trr.
ilri t,rir, riIi I,."...iru,.,,r,i,,r'r,, l,jil,,r ,,..,,,,rri"..,, r,,,.r.,.,.:,n rirli.
,1. rt,,l: ln:rl ,l,,ilf,r,:rz. lrl,.rr,1, r,,11.li.:, L,'n,,,,rIl i : rr;,liIr.ri,
hiln,tizi,r lnrpii,lx.r', h.,,rl,li,. llrL,Il, rr :, rit. i. Iu ,,,.c{r,. ,..,z ri. ,.rLI
lirrr,,,,.1,. Iri ;,liIrir,rttt t ,Jr,....,,.iI|rj l,iI:, tr tr' :nr,t,.tirrii
in l'i(,litr, piclonetlilc, lUlx,rctlozii rriratri
rrcr,li iIl (isril(,,
(ind (!x(n)(i:r rrir il.ri dr lirti tlIc nn (iu|ctor rle\iirelter ri::rl}iiI,rrr.r,
rr orgrriNnrrhri.
1)) O I i x..r i a Nrn.rcr1il,] jrr sl:trilc t,NloI)gift. I)r,nlc ti rtoicr,
nrirultii rlo (lrrrz(, r'on[lc qi 0xfr.utrrrtl'. l} .rplrr,;
lriLn, irLnoiil(, (l(, rk,shidlll lllr orgar)isIIllu,
. io (xtzlll. 1rlf(,(,{i
bllr!furrio, r jrsilllt i iI(tx.11,il)i](,, rlinr(l(, ((r(,rrl Itriit, ;
lrir .'ll.ltns])iINtii
?o (ilzul lrcllr(r.ngiilol al)0nrl(nrt(,:
r^Jl Ixllir,l(lu rl(l li)r luo ]r (,r)loqiikr'BflnrHr!i
-. irI {rnzlu,i rk, insulioiotrti rir{julrlolio.I tr, rrrr'c rt,crk,rru,;
hI coli(i ronrrl(r In,in Icrllrr,0roN No oli(ri rl,ltrlo I)(, (lk! retli.\i! I
in l)orio:rrln lrllllri I n0r' lxrli irrto(,1io,rs(f (t,n{IriuoIlir, trct)l r ilr.
01(.);

lr sl(,llxi.Ulr)ll(t,itc lcuir iDsolir(l (lo r,(l(,rr(f.

OligLuil irNol(,H((, i]l Illxl lInr,trtor ir]lt1r sri,r,ik, tcl,r'iI,.
tl t , ; u,,r,. ,, .r:.r,. t'i,,,rr,.j-||,\:'i. t . , , 1 . i \ i r r , r11.l,Ii,.
"
rrrx..li,,r |l,rliiIll,i. lrirr :r,,"r rrr,,rir.,.r, rrr.lr ir...rr
.t n"\r:rl'i'r',,z,
(xrn{,ir,\ca cazrlilc olnd t)oalr.sir Hr' r8tol)tc I ill.\lrrlxrel ll.rstrri si}II'
li)rr. Anuri[, or ti oliguliN, p(ut{r rr\-e clr,lrzr IrIxli. Hi r,\ilarorrrli,.
\,tl l , rr ;r,:rt, ..rr\, ri I'r ,ri7,t,. rl,,r',.rrt,,r,.t' r,r ,,,. rn, rr rx.
tf,,r, luyi.,,, iI r,t'rr,t,:,||,, qr,\i,li,.J, rL:,r,1,..,r. r rtir {.rtr.
Anuria aI)rr,r. ,li ill s1,ililo (lN No(j trN nralic Ni I Irj u.gn,lt, in l2z rl(.
lr.,'Il,,,rl.i,rr. l(,r',1',,r.. ir r, rr, I!ir , hi11rrri,:,1,. r .lx{.ii,t :,"Il,r:.
rt'rf.,l||lrri Drir: ,..rI r r:rz,l,.:rnA:,i: ,.:r IIr ,,rl,.rrirrrrr rrrrrrt itrrr
rr,t,r'.ln I,aLt,. i.irlIri.;rrr';r.i.r." Ir',,1rr,, I,.,,,t,.r, ,.\rt. tr.UI
,i,nrx .il,,rl,,rnri. rr' .r,'r,,,1,,orr.r,.ir.,,r,, r,,,;1,. ,1,.r,.r.,,in:,, ,1,. .,..
orelrerr, o irmll i('.
:1. (]:rrnrlrrrk' calittrtiv(. nlo nrinii. ,\siitentlr yir c\i]n)ir)ir uli il
itjrt puru:t rlo redere r)rrro*oliri ti, (ta(i ruc djspozifii jrr ll{i(,it s(,r.,
v,r rlot{r'mina [i dcusilltel ei. llodifir.ililt, (j(]rNllrtrte t(] srrrrI|ltr.rri.
,

328

r ,

,,rirln,ulni slln Ic lislr.cazir, Iini Ia yiziti. ?cn1,ru a pLrtoi! dcscr.ie

rrirl irr nxrl sisioll|riio,
rriitonijr tr'dnrij sir .ruoaBLli cai,x01.rcl.
,: lrr., i\, :,l, IriIir , lLisc :
t -IM,tn. I tint no n,,t., .,r,.,,,.I1,,r.ri A:,t1,,.n,r.,1,.., triF. C.r n,,rt,.
r., \.,rIr, ir li.,rir, I.,fr.,, 1,.,1, l:, r:.lt,.I ,t,.,trr.,.r |lrriLrt rrir. ]:r
l,nll lL' lri.. I Il,,: r : Ir ir,ri ,1, t,:I,1, ,t,, ,r,rr,rrrrr r.J , i r|hrri^rr.rLrI
,nl,r',rrr,. .\.-1, l.,.I ,.rt Irinr \:, tr r,'i t,.:,:1,,|N.t., r,, ii r,rii
't
rL,rcl)jsii Lr lrl(rr.o ri ir)!(r's.
r",rr,1 rrj11.lir I rrl ri, r :II,.,L.IIL.iI.||I,.,",|r,r:rrrr, ,trn]rLLltsirt|
,,xir,,rl ,1i,, r,.,.,r, ,1, , r ,, ri lI,,,.1i,. ririi. I,, r,Si , b;grr
l|r '.,rrx .,,.r,trtr,.,
:,\,.:, ,, I ||tu.,11 r,rii ,, Iri,i. ,,o trn,l
r' !rrIrl
Ji I 'rirr. ,, .t,,,rri\:,. Ili..,tir,;r,..rrrj rrlirr:r .,i r:r as,.r, ,r
r ul,,:,r1 urri ,1, n l,iH,1

Lr r,azLlli}Ilohgi|r,, ix l)oliLui(,, (xrlo,rr'or\ nrir;i cslc foxrto dos,1,i,,,. ir ,li,,ln.'lll z:,lr.,r,r , in"ipnt s:,,r ,r ,:,2, i ,1. r.t,.r,,z:t ],rrlxta.
rrir, ,.r,,i.i, ,,r, ,,,I t,l, I i"'1,li,ri, '.:, .i ,,t,,' I I I x I r i ! rj , r st:rrit,.
'
rk, (rigrrrjr.,_(ir f( l,r.ii, x{,Jlit(, c1ic. ((lxr,
r,ri ill Hiiirjto iizidogi(1r cu pi(,r,
(l(,r'(, rnrt: 11{r:rIir,
(!rlc
c\tIrrlrrlttliri, cr hr (,Iorlur i rrrrrscirtrD,r: ro-corr
tx'
ilL'r, '. .,r iI:, , .t, x.Ii":,. r,:,ll,.I:i t,r,.II s:, r,,li,. t, Ii.
I r1,flr,,, .,ir s rrntitr.:t |,,z rit,. ,.ir,t
rx.ir |x
rrlr.r r,l,. '",1,,r, ,. .,,r,,tn'r,,'r1i rL,,r'rrrrrli .ri rrIir ii-.,.ti,rirdr
iu ,.:,rrririti , xu
-,1r('. t,l,'r..,r -i riIln.i , ,,1 ,rJ,.rr l|r rn il:, .{rrl,:r It,.r,,l,r.rt,.,,nut.
i

.\,rli,l. in.,rr iL irr,r,,,,rrl,,r.r,.rr Irilri; ,tr\irL,.t,nrnri- !.his si,

rr,rjIr,')iIr.,,ri\ .i"l'Ir,,, Irirrii ],r,.zirrri rIr,.:rqi ,.rrto,rr',..
srnjrt.l, ,1,l,,r.,,r.1 rri.L,, ir I,,.;rI.,L*. IIi., r,';I in,,t,iN surr rlorrr-t,rurr.
,irt'l ,.,,rlir,,r,:i tx.,:,11.,,,1,Ili'r,.. Ir, lnIlh. (,ri IHI:, FrIxIir,,,ti,rLr,
oslo lrrll)rrr', r'o1io v(lr.zrrn., irst|lr)i,,litr1oru,o (iu o spiil,i,{.lL],ii itr) c&rno.
l)rrc:l H. Iirlirr'i l)ilrurirlx l)r(,zorrli(!i ninArlui i[ r1r'in[. s{f va corootr,
,i,r,i II :,i. ,' :,lrI t,r,,\i,'ri,,,lx. .1,rr, ,.r,.r 1'lrr rlnrira l|r..rL"t r,lio,
(rrl(,u ut(flir r'l(,.). liistf ir]t,ortlni (1r ul.irrl sii Jio viznli irncrliai
}, ,.,risiIn,. ir'I,1,:i ." r,,,:,r, j'riir t'1, , ,,r ,:r..i Fi l,i'.,1x. , t.,:,r,.x

,ll,l,:i Itr :,r,, r rr rr'',t, i,,,,,lr,r ,l'rr .:t ,t, \i :, rlhr,r,..

-\ur)r(r1)1r"\. r)x,rlir.lnlcri. s(lritll,ii (,ul(,ru(lI nrirrii : xtrlillh jnr
,,,lorr,:rza rrrrrr r ir, j ll,r,.1.t,r., ri'.1r:,11"li p ir
id r, u rr I rri rr,z.
F,.r.,ir,rrizi :, hrrrirr.,, i,/r,, t',,, /,ri. :,,.xiIl,t,ii, iti,. u, tirfcr,iur,,{u .:.I l,rIn rr,;rrr ; :rll,:,.rrrr' rl,. Ihrihrr u, rlL:r\tr -\errt,.: trit!r.il:r\ i ,,r ir. r,rll" r. .,1,rir' , i,,r ,,,ur,,.,t',, ,,I1 , \,.|'t,..
Asislicntl lrc siu.cilrtr 1,l1 (,r'i r]c cilr ()ri tulllrinistrorzir bohrvilor
rslfcl (to nrrrlicxrronl(i. ri :rtr,lgii llurli {,f(ir,iului lor rsuu, ([lorii
lrlirlii, t)oniln l nu li nrgrijorN(i.
. -,\sl)crlml uririi no rlc csio clirr 1x rl|rjsiurrcl I[rnsp,r,r.elrl;
du],ai, rx tinrp, c:r l)orr1. dc.lcni trrllnrro ri in llro(l rrolllal so fornLe,rzd,
: r r r r

329

asemAtrdlor lunrului de tigata dcnumit aubeculi'

Spil,le do uril]a olo calF url
rezult, di]t coagularea mucinei
ppiteu;Ie
din a,cesle cai $i mucusrrl
;;;.-;u"";i."il;rtei celulele
pe futrdul vas[lul
genit:ule.
repede
e$azd,
se
Nu'becula
orpairelor
-'
Dacd irina oste tinufe Ia rcce; da,' urcori ii Ic temperatura caru"_
rei. ilvfure tulbure Dri[ procipitarea 8r,ru]ilor minerals po care l'
ma,i

tntli un nor

caxe

orrotonice, asp ctttl tulburc rl urjoii poxl'' li dalolii

"nro.,
se"rriifo.-rnir.ur;le, pitoiutoi oau microbilor. Urino poate li lullrur"
ate s5, se trrlbure oumai dupe ]r li np de.Ia
liu f*-J*iui*u'.,
"'po
.&2,
aspe.tu] 3" daioreqlo unei pLellte '3u cljtllr'
emiRirlne. ln Drimul
cronioe. Iii-oa'd.etormiqei dd puroi, muoozi!6Ii qi seruri minertrle cllo
au lrodfuitat fux iatotiorul vezicii itrod tEaiute do eLiminare-i u1 aoesto
in iii iu' rroar"" tE vozio[ o fermo[t&lie alcxlintr. caro favorizc:l'ziL
preoipitar;a 6d,rurilor.
' fo on"lu cazuri 80 pot liminq cu urina, miri calculi. Ctrdetol lor
pe funaui vasuhri tn caie utheaz[ boLueul atrago atentiu prin zgo_
motul produE,
Miroaul. Lc:u,ii volatili aromatioi dil u-ritr, ti conford' uD mhoi
,"" *-aneior cu ool albutio[ului. Ulin , tru pdstreaz'' aoeBt miro8 doclt
l! staro ptoaspdtr. Duptr onisiuEe, prin Jlrncosul fcrmotrta'frcI alcl'
li4o, a capntd, un miro. amonicoal. lnlros rLl'Iuot'
zihxret, in'liiic' lu
h. std;ih ltrsotito do acidoz[, oc disbotulpoatc
prczonlr uu llrL'
vnrslturi abu[clenta ai clo lunEi, dluattr, luilrr
datorLra
clorotormt
.rLrr
ale
coaptt
frirctr.r
ros particular aromaiic, de

"oilff,

acetonei.
Itr caz do formentetiF alcalind i.ufravozicule a

ulinii, ca prozirlll
duptr, evacu0.ro Numoro^se sublt{Lulo
aiimeliaro t*prum"td urinii mir-oeul lor ctlracterhtio'
Erdctia. drin[ ln st4ro normild aro o rr.Iclie aciill, avlEd p['ut
sub 6.5. iteactin utio"i depiods to pr:imtll Ilnd de regimul alimeBtxr'
Rosimul boeri iE crrrc x;idifiod, 9i rnei mult. lo clod roglnul v.!gs'
taihtr soJd; aoidir:rlel urinii' ace,sra pufind devent 'nrar, al'alltrr'
Urina. aupl oliminar., 1n .ontrnl m ri ind lunE' crr -x rul.!l I lpr._
manrr.iiei aro[iacalp. dpv " ol.a,Liad,, io urnll .arelr, lo)ta[rL caLcrcr'
;;;il;;--;;g";;i"d'qi.rrbon.rtii terogi s' pre(ipite' Lrrin'I deYooiod

.i"nsd-;;ouhonl imcttirt

tulburo
Bi lotid[.
"--"-aual,tu
rrip""coiad ?i a,loa.Ihd Iasorizazd precipirir'roa' sub8larttolor aiioivate in urUA qi[ormarex oalculilor' ro cSils urina're'
Densilalad. Acoasra estp bine sd lie delerminatf imedixt dupl
sraro dizolvari
trti" rr,cire sdrurile min"rele a'flato lnmotiv'
asistD{a
"-l.i.a"."oiii
Dir
xcest
schimba.
8s
i*"ipfia ql aqticl deositatea
330

f4trl;latea. Catrlitaletr sputei esle variabila. Ea depindp tle itrtnca'ilor lesli. it *t"-n" si" i"tlia" t"" proce"6lor palologice do la [irelul
'fo bronsita c;tara,ld, pdeuEooic, l,uberculoza incipienttr el'c
rn oron-'
"^-i..ii spulci poate vrria intre b0 $i 100 mI/24 de.ots-'
(colitalptr
popmtu
pur*ipcra,zie. caverne rubolcu-IoagP, gangre[e pu]moEare fl
ore'
mI/24
de
pillll
ta
1
000
i'Lonar ca ntitarea 8!u1ei poate a.iunge
uoul
pulmonar,
a'
abces
x
unui
llsacuarea nrin ca_ile rpsphalorii
o cartitate
.""i"* i."J"i" tr" a unuj ntisr hidalic poale delprmira
ci ;ai mare als 6ou1i. Elimi[area rceslor colePlii m-a8ive d0 purol
romica"
:au exsud.at prin crile respirarorii poar1,, Ilumele
'lp
cantitato; de spura erpeciorrld so reprezintd grafic itr loain
d lemperatutr la Ie[ ctr li urina, lo ou]oaro rolie'
aemli',
-{eacctul. Aspoctul sIutPi eto ln futrctie ale cousisteDfa,
:
Dsosobim
vlscozilatoa
oi.
r rrnsparenlaiqi
acleroDl. bitre
r, ;) Snula mucoagd for natd diotr'un lichidmrriviscos,
putin
trtrEsparont'
sc.u
m{ri
mult
nstratl'd.e'o[loare,ttbi_oetrulie,
sr,iti,lnuooaeA so lutillFiie'in iotlr,mxlia bronhiilor li- lE artmul
t,r'onnic. lt acesta din urrnl, rpuro coEtitre numuroasc dlpurl mlcl
oD0ldscento do subet|rnld lo rcoa8a' lsometrtr'toare uuor Tlerto d0 uuos
nimelo d.e Bputd lerlabr,.
hl Snuia Durulenti nro o oollgistsnl[ cre nrrnid 8xu lichidi' de
,.',tnrr'c q'dlbui6-vsrzui, dosEul do omogeud,. Se iottlno,'te ln suptt_
orilmooo"" 8i 1[ caz tlo (leBchialers $ LlEoi oulsclii ltlllllonle
"ri;il"
rliir vcoinltatea plimlnului intr-o bronhio.
ol Souta Eorotrru o.ro formntlr, dinlr_un lichiJ lralNprrent' uior
roza,l. rlri,poriE ou uu slrat groB tL".l'uttr. -\prrs ln Jtt!z.l' $i oderrlul
rrulmtrrr:trl fiind frrmlt,, in prrlo rlilt rrrul \.r[gLrin crro a trxnssrr_
iIDt rria iorotii alvcolori.
rll snula Dsoudornombrfltton.I c.{, fucmtrtr,,linlr'ull oI:8udlat cu
toarro'mrittd fiurinl,,.o!J a,pafd sub forr0:i, do mombTirne albo Uneori
fitro ramili
ill*t"i"sto iltu lorml broihiilor, rdprod ttcitrd 'els moidilteria
larinAcoasl,l, spurl, apxrr lo 6ro4ita difteric-t
.utii*l"l*.
prLII'
deschltl'ru
ln
cazut
ps"uclomombranoalii
gi
tn bronlil,r
eid,nd,
hoparic, d[pd o]imiii-" r,rtnrrie a ui,ri itist hidatic pulmoorr "lrupot
apdroa ln s]utd'
ii"t ia"t"i hidd,tio sub fornitr ile Yom[,
hi'latice'
vezicule
""i",
chiar
sa,u
Ya,riabilo
tlo
md,rimi
G
_-'_-boo"i do *"mbrrno
ei llsmoutizia' Vorbim dc hemoptizie 'iDd sputa este lormat5'
aemL clr rtrulte
din si-ose. Singote espoctorar est6 licbi,l. biao groB
Sptlma
rto
cu
stral,
acopbrib
t,rrte rto-asr: Ia supr.riattr, oste
'10 (aucer
de
tuh'r'uloza
in
caz
Irulmooard"
surviire
ii"morctizia'
nulmoirar, bronqiectazie, giugrdue pulmuoxrd, iDlar(l' pulmonar lr
irncle imbolndviri alp inimii qi alp orgiEolor hsmrr,porei'rce'
343

l)e mrile oli e.cte ne(esar ca hel)loptizia sA fie deose}it;, rlo hclrlr,
ior,rp7i. Ir ,.,,2 ,1. l,.r,r:rrcr'rpzri. sing,,l. e.re.le r, rltc ori .,uxjrIt:.r,
dnL, intlu..Dtr a,i,lrlDi ,.lulLidri' il.r'r. t,rrlll nrtli.. (ontino r rI
zilhli r:,r ft .llll i ,rlir,,put:tr.. r.i xrc o fi.,ll lip :u irli.
l)c nr le ori ll}utr llrc un (atl'lr(tcr nirit. (.r:
I) Sp"t nnn,o-purnk,xt:i. forlltnt,i (lir nrtl(us alnestcftrt cu purr)i.
Coloratl in rlir gElt)ui sar rcr.zni, (lIt)ri rrlo ell tnrroiLrlui, ,sILrlir
(,ste o}rci, DClr.aDsprrcDhi. Ilur.oiul lx)llo Ii ameste(at ({r llucrN,
fornrirxl o nrxsi or]rog(,rrii, iilll si tie sul Jornrii de nronede HlL plr,ci
izolale iu rrrsn rn( riuiuil riml lor'l)inr (lc sl)lltc irnllrulari.
g) Spula soro-rnucollrnrlon(:i Nzulli din : rxrstecxnc:L l)Lll)iullli
fi r rrn{rsullri iDtro llrrls:i sotu:r.si. I)c ol)i(ei nprr{, intr'-o (,anliLal,e
rrrano! caIc, re(oltatii irll.-l|D l,(r'(u.u do sti(ili. s( s(']Irri! l patm
slr'irlnri : itl.atlll sul,uior. slurros; a,poi stlltlul srort! irr cru{r iro{,ti
Ixr'li1rni Dnr(,olnrrnlent(, ull nt dc simllll sros, IiIi ]n)rlilnri n)uoot,rIrli.nr,.. ,1. r'rl',r,r,. r,,rrui', .)r sl.rrlul rt,,rii,r' !rrrIlj;F, t,,11rjIt ,liI
lmroi. ,'\.(east5 Fl)rtil l'stc c:rm(l(rislirir lxnltr u lrrr)nli{-,(,1{zio lsi gt r,
gr.lDil prdr)onarli.
It) Spula sanlllrinolerl:t cst{, o sl)ui.ri nru.onsitr Durulcntir sltu
scroaNl elc., ll cirrr s-n rllx,slocrl tji singq. AriIel rivc r ipulr[ urgitri(,
sur (dlii,rniris diD l))r{,Irrx i(, slntlit s('tr-surrguinolontI ditr (nierIlrl
pullrtonar, Nluta l{)znld gdaliDollil diD (:t'nc('rul pultnonrr, sJ)ulru
1)rllDl"ltlchis, riHc(]nsI! id(rcntI (liI infa(lul puhnoD:[r. sxu fipuliL
I'rlrn;. f(li,li, rlin grDgrJn:r lnrhrx,n:'r.ri.
( 1,'ot!4. ('tllolrol {t,ul.oi estc foarl( \'ariurl ti dcI rllr'',r.i t,rtt,,
j-trrr,rrlail ln,rrllrr nurllil'. irrl{,lrlrirr: sput t ll,1,Irr]
lll,),
:rlbA{orntic; rl'utJ rrucr'-lnlrulent.i Il.o o rrrxul, (JIl,rli'.'+l',
\.,rzUiei
.l'rrrnlo l,rrrrrl.rrru {int grll,on..\'',rzui. l|r t,nrrrrrrnni,., rt'ulI :,r.u
r,ulorrxo rugilrio-{,1i,riir)rizie, in g.rxgrerur InrllnowLrS! hrulli!.Ullruliu,"
irr in rifxL IIl t,IIILn:rr e!lr LnrDri-in.l,ii.. adcl+|lr, ili \,xr ti t,r re
vis0o${,
Sprrtrl l)oatc Nil i& rulo:uea nDor sulls(rl1c stririno, cu care rie
xnrc31otri..{.slfel uncori. ilr uIDul. il)hiltrrii praluhli (tt flirrii, ])olnar.ii
au o sputn all)r]. Iirricrii fi lochi:.itii, carc iDhxl.czii. t[ll.f dri (,i,rbuno,

rI

L,

.liIIli

nr.,rEr.r

'

r'.

1(,t0lul (olo]'eazA, fi npnlr intr-o nurnti, t(rde, drrtoriti, imprcgDirii cli hiliruLini, (.lllc s(: oxid(.azi in bitiv(,rrlirli.
,llnr/su.l. Sputr nn :rr.'in gcDcral r)ici ur lLiror. totuii in unclo
:rt+,1ir.ri eJ tir.zr,li tn iros li,li'1, (:t dr t x,Irt,lu Ir d:l.tra1:a br,I.
,{i';.rJ\tsrDcl.rtl{,r,1rloia,.'rc. T i3.ngr..nx Irrlr,,uIird, rpula ir,.,,
leridilrt. ppnprriLri. insulor.t:rlrrlr. ir r.l' .'rt'ulJlii pIlrroorr,,.
sputa are rxirosul pirninfului .\au al p:liului u l{rl.
344

Sputa poltte si corrlini rnunrite {oflIati[ni macroscopice canrncl,e nticc, caro liot ser ncdicrlui pentm r{tl1]ril;rea diagnosticr tli.
Din accsl lnotir, Nistcnta l.a recolta diD (ilrcl in cind prtind s]ut[
irfr-o cnli{'I'ctri. Plarind rutin pe o s trlfrrtn inchisn h culoare,
rncdiriDl Ia lutea si rernnous(i rrxunrito chnrente : chelguri de fil]rini
llrda c rlul)i url)(,riz:rti:r hronhiilor; st,ir.rle Ou$lrnr:urtr (fil)rc suhlir.i.
IIU(I)Iso. rlsu(.ifc in fol'nrd dc sllimlc. fonftc eonrt).r(tc, IuDgi dc I :.i
( rI),. i,r':,,.1clrrli.a
l{,lrlr sl'ulnlx'lIl rilorrle:r.rrrrhror.qir';rircrrrl,rarrr.
(lin vozionla-nrarri n urri chist slln foln)r!iuni cal(irre (u aspe(ilrrl
unor pielre, rlunrit( l)roniioliti.
thloarclr, rst)eotul rii cxDlitaterr sputoi e\I)e(toratc pot fi de
nlulto ori denalnrllr l)r'in rnele liurente t1rn nr({1ic:rDrenlc ingerxte
rrru ijnuto in guri ixrinto (lc erpctortlrc:r sl)LLt.i. Din (est [rotiv,
in cazul expcctoriirii nnor spntc rna.i deoiel,itr, eite l,ine (,rr xsir\tctrtu
si, c )tlo)eze (r\illllra bu(tlli, bohrxyilui.

GREUTATEA CORPORATA 5I INALT I'IEA

(luDoal,lro gltutitii (:orl,olrlc csto irnpo trntl l)enlnr aprccierorr

sl[rji dc nnlriti(' rr lx,lnavului, l,cnl.ru Rt,rl]ilire:r dozei
lierxpoutic(,

(le nle(liorirnoDle, p{'Dlnt strbilircx Dru,sititii (l,tl)ri(e r! orgll.niBnnthri

(it, fi pcnlirn unririrr:r ( volutioi lnlil)r.
Sl,ure[ (le nul]i1itt n lDln:[rrrlui rulull t)orrto fi:rttre(,i:tl{ rii flri
(finlru,r'i r. trIodifictrril(, in plus sau ill firinnr, de lr! r.lrlorilo (]onNideuto
(ir nornullc, Hc pr)1 slxl)ili nnllrai l)riu I.nlx)l.lrrrerr gr.olltdl,ii (]orl)ortl(.
h ill5,l1,irx)a p(.rsoanoi [cs],ccli\.r.fi lrr g|'(lrirrt{rr r[ntetio{rd inrlx)lIltr,virii. l)i!r rr(('il n!oli\', c o\coplin. crzllril)r ItL criro nml)ilizrrroa
il(,tivI cs1,(, r'oIllninrli(,!rl[, Ae ltl dctorll)illir, groutlll(,r (or]n)r{I[ I
toti bolnr,vii irlcruttli. Se vt rt)ullntr lr oiDldlire : bolur!'ii (xl infllr(t
rllil,ctr,ldio, tr,orrln)fl(,1)ilc, (,ci ctl

lt.:u

rllirnrr', stitri (le lJo(, hclloraEii

xr,r d,uri NrcrNlrr nr intirzi:r inntilnhur trirttrurent lui. ln cllz rtt

dubiu, isjstenln rn cere :rt)robnrc:r rr((li(.Ilui lcntltL cioterire.
O irrtorlurlri deosr.bit{ o prrziDti (inti]ircr sisi ruti(.ii ir
srgnxilor, unilc (.url)r pondert i ostc uD i ali(iLr dire(t r\i inlrdirrl
r$rrprn stdlii dc Dulr'ific a dez\otlirii (opih ni.
C:iktdrina hol I arihn, .riltlti se ftr(e ru bnlnntele illtropoDretricet
{,rlo NiDt, h&IaD1,e de !ip deciu:rl, (.u {,rrrsor ti grenlali [ixe, collstlllito
dupi p rcipiul cinf nlui r.onun. Grc[litile irdi(i, v:rlo diferite
ir lunclie dc rliitrDta Ia crrc se rfli deh prlr(tiil de sp iin,rl ba1:lrtci.
Irentlu u{uraxerl operftliei de (lintirirc, ci[tru.ele sc coII[ectioneazi (\r
(toui cu$oare, unul }etrtru r)rodificililc dc gr,eut.rtc Dini h 10 kq
ri .rl1ul tFnlflr \rrillirlo pina h I U0o g. lli,jraril* de l,,rl,rn.aro clp
r'ifitarului sint tr rsl)use de rm sistrnr de pirghie rerticali piru, aprclil(,t11.

315

de drelul oehiDlui, Icntrr a tolesni citire:L ralodlor. Pe aceste

ci[tara bolt]awlll st[ dc obicci iD picioa,re. Pe rnele balantei postflrre tul ale pc talerr rllalc sti bolnaflrl este ]rer-ezut cu un seorrr,
Ientru a ulqurL cinterirra bolxa.rilor in sta,rc gr&vd, caxe nu ])oti stnil

Ie

picioarc. Graalerca rqiycl'ilifaroa lialaI]lelor sc fac la aNrnitro inlicrvalc.

Chteriroa }olnayilor pc accste balanlo so lace foartc uflor, hrFi
:aaJol lor r'lc s, DqiLiliicl. so lin ir.h7i ld l uu g ; trri:'liil, rrri rri( i D,r

arutdeobio.i"..i7x,c,lf.inrarpl.urillzatorn.lini( e,lrrlllrlIirhg. liil).

I[ainte alo a ofeotua cinlii,r'irea bolnflvului F0 1'a y.r'iJica dc li(xrar]
.1at5 balanla,lislnd sii, osciloze vhlul irdicatl)r mribilpini, o(! so oproqt(l
]a virlul indicator lix ol pllnetr ui zcro. D&or:i, Lalanla uu oslio cchilli'
bralil, ri toi:to fj reghtr-i cllrjttonll si,(tcrrn uidocoroctio, (Iuo 1,r('('
t,,.rlo inri,r:r.,u1i ,lill r,ri'1 1'rlir,ti rn1r,,1 rnr.lrjc5, A.oslr osl. l'',rIr:r'
,tirL r-rrrr ,.rrr''rb,nizurr.,l, lix,,r iD pl lungir."a LraIDlui Frurl rl 1,ir
{llici dccjinalc, l)eiito elnro so intyhtrosto o piulilr'i, de o oillooarc g'rolr
tite,,upropiindll'so sau dep{,rtltralu.so, ?rin lnvlrtiro po quluL, al,'
r'rrIttul dc rlrjjin:tl l,r.l0i,!, i. nlcn.rlind pirllitr Ie lnrnl,ul ori7,'rl.,l.
:,,r1 bc]^niei (o !irbilofl, ix purctul z(ro. uLIiri hcluLln ilrri ir,
rit,iliLIu.
DupI aduccr(,i, balanloi ln o(,lrilib r $c imolilizeaztr ccul iidi(lli,or
lrrhiziud bralul talintri ri .,' iorilA bolnavrrl bi sr a!,zu po ,iDlnr'
Di(;l bollravuI osto arliDaruirr ol Yc li ijutol sau aqpzlL do asi..li'rl,]
rtlrL braE(arrlicri po lncul1rl ,'intorr ri ifig. 1G2). Sn flnrcciaztr J.rr, rr
ratrir aproxiDrcti\_A ab,,l]lar ului (.vcDtrral isooi,r'x,(ol,llix r,h1.iir r.i
,rl)oi $o lmping gmut[iile Do ct$oanc la 1'alorilo apresiatr]. So do'r(t' i(lil
L,iitul lrrloLtoi ,ji tD luDctic do djrocti& de ,l.tlosaro a rcului ir.lii rr, r
{ r,'r rrIr .l rn greutalilc,nt}un 8ell3 8au ln rtlrul, pili co anul itr,li, :t
1ul, be .lxl,ilcJl,i fe pu[otu.I zoro. Bo (ilns, do po scirc ' rrr",,rulrri
rrlurile c,blinrl,. ti so imobilizoazii, diu non bralul l.rclan!,'i trr r, ttl
iDdicator rDbil, clnal bolna:vul poate ptrxr8i ci[tarul.
PeDtr[ ci[tdlirea bolnavilor cana nu poi 1i rialicaii din pat -c(l
folosesc sint&re specia,Io, cara stra,bilosc gaeutatoa boluvului lmprculll[
u.cca o.palI'lui din carc oc bfadF raraua }a,luluj. o lo[jeriei qi fl
'.u
cazr,rnramnlrrlui, obtinind Sr.ulatca rcalS a bolDa\1Iui. Unole tipuri
ale acestor crntane slnt prcydzute cu roti Ei 8o inllling sub patul al
, arlli bolDrl lrebuip cmtdril. Ai(i, cu ajutoru] unui sislirrn dc ptghii.
L.,lanta ridica, I,al ul, ri asl lel se poaie elecl ua cintdrjrci dupd mel odrr
ubi$uittr. Dupa lormioarea ctDlrri-rij, balabla loal" Ji ltrdepartsta,
de Bub ?at ii utilizati la ur alt boltray (Iig. 163). Alte tipud de ctntare
fac corp comun cu petul iar procesul ile cintr re este Iacilitat pdntn'utr mecrnism elect o (fig. 164). Aceste paturi-cinta,re 8e folosese
in speoial in cazurile cincl aportul fi lierderilc de lichid,e con8tituio
3,16

obiectul pernralrlt Di neintrerupt a.l obserlaliei bolEal'dui (dializ&

cxtra,re[a,li,, hidmtarc ]a!i{i.5 etc.).
Cfurt{rir ea bolnarilor se va tace totaleauna dimiEcala }e nelllinc ato
dup, rc t,ulr:r\rl :r irr'rrt scauD si a urinit. ari-Dd a(ci.i hriru de
spilal li di, i .. r. l,o:ibil .u x' clrfi I iIl ir ; I'eD1IU ,.Ll, riri Li i e\x, tF

/f14. ,d7.

- (lrntirif(a

bol .rutui.

lrlr, ,4, - ClnI.irea

zitie

lroln.rnhri 1I Io-

rez!nd.

.p !ir .,.ndrI rlllr Btr,rrlrl.a tolxlil gTrutrt..a iltrLlri'nmilrloi,i u1ctl.

t,ir,inloi. In rezul (intiridi bolnavrlor.u p:rt,6e !a utiliza loidoar.n

i,.pla,.i .azrrDrxrnenr de pa.t $i accla{i til'

caotiixto de leEjcri", I
r.rir.r grpul a 1c. impreuDt rU aieea a lal,Ului, 'ri
se !a 6crdea din gteu1a1.|l
tL,talA dtrii,ritd,.
Penhu clntirirea sugarilor se utilizeazi ciatarc la care r]jlul ilin
talerc_ eJt lnl_ocuit cu tn co$ulet seu 6cafi, in care Be culcd copilul,
ior elelalr talcr ru corsoarele cu greul eli ti:e. t'urarple ponr ru copii
'
functioocazl
l. acelagi prio(ipju 3l greuta(ilor noncliDl; pe uD tixl
do pirglic do Iungime rariabiltr, .rIe echilibleaz, o srpul cl tr c r;abita.

brtll d( t)ir'{hit (oxsltlni. .l(eite cilltore lnncliorloazir (lc

objcej ^l1i
t)inri h 10 lig. lili'Filrf t)r.\ir,zr(e cn tloi c rsoaxe. dinlr( clrc
douir au r.coprrri irlenli(r.n :rccl{'Ir tie ll1 (inttL,nrl trrtroponrctri(' rrli
lizat h xduili, iar xl tleilr . Ixinlnr otlilibrxrer (inr:[ ui flr grtrtr
1xlc,r.(ute(dorrcic tr . u b coPil n l ticzl)r il(ot cll ora zitl (]infir ililt )r'.
Ni

un

(linlil

rn islnxl $ {'r,
si (ltrttrr\lr ltr,lrrr\rLl llLti.r,rrii
'lr I)'rnr,loir. \xlr. ui )i trl

/rir.
3.r8

,rr.

l)rr rirlnr

\rerili(rr{ l ir(rs1or. .rinli.lxe sc flco lll. fol c, ti la ciriaxde ltro))orr(,trir.r. (l rlul lor ile .crriLilitato cslc linii l1l l0 g.
('i^riir"r'iftx sllsltrilor po rccslo h,rlinlc *i tacc lll Id clr fi r,intilircrl
lrlnllnlui. \i.riti{iruca isi corect;trca l)ilrntoi 1)I1{{r(liL fj rIci chlirircrr
l'nrl)riu zi:ii. ixlru(it stgarrl csto (iintiirjl lil,1 hnhc. l,e cirlinr s(i vx,
rs(,zx rn s(ll1({.illlr o flarr(rlii; so \-,r oi,hilil)r'N !rtx)i finlll.r,lr] rirr rir)torul
cchi ,lf rl 1r'r'ilcr l.lrrsol ncgrr(lil, dupi c.re cirtirilc,L fc r.:r larc in
rro(l r)l)isruil. (lill(t (inixrIl lrL ale (ursor sp(\i:rl l).r1rlr echilil,r'r,(,a
(r(,rlii'tii scuio(iolor, groulrtcr oxxrlli x :Lr( sii(r'N sc r:r s(ridcll r^rr ruod
osligxiolill rlin gllirrl lt{,x r],irn]ri:i. ('r,t)ihrl Ns ]'o?nic (r^lnilri $ illrhriiln(
('r r)l,lisIlir de i so s(iirl(N grrrlNlcr irrhr':i(r'lrrirlcj. Sc 1,r rvcr glii:i
(r. ir lirrt)ll1 cintr'iririi. (t)t'ihrl iii it(,1 liltitlil in (1)fn].1rrl sau s(afa
l,xl,,ll1oi. ri(i l'ri,r(.r'iril, \ irnrrnio irrt)irrli(,ri (,i,,ih(iilo lilrrrr.e aLr rrcrrlni
irr(li(1rlr)r firir(l irrlxrsil)il:1 (,irl1irin,a.
(rirrl lirlilir(:a sri Ill(o lrur]ri Ix,niflr sirl)ilir(,N (rnlili{il(r'(lc
ht)1{, sItrio (]o 11,l)il rI oslr llo\oi( rl(, s(,r'1rt{ 11' gr,{,rrtiilii lex.i(,r.ici,
Ir('r1flr (ii. ir rLC( sir ,.rzllii, inrclrsl',rzii rlnrlri (lilcrfnlrL (l{,grrlrrtxl(! l
cot)ilullli ir),ri'rii',\i (lIt'i llirrrlaln'.
(lol,iii ,rni rrnliir slrrro g]'r!:i. r'rr'1l Iu tnll ti \czrli t,(,rirlrr.
\,,r li ,,iDiririli irrl''1'Iril ( lNrsisi{,ni,r, r,rri' ii !l lilli: in l)11(r,, i.'llhrl
(r. irrtt(liri rlu t)ii sir l)ililcx F(,rrti1,ii(r)rrur{r rHislionii si n, (,hli}r'ls(n
{irgur';i, r.lk.ulirrl (litflrrll {lr gr'ollllllr.
,\1il t'(frll'r rirlririlr:I r lullrlui, r.il fi t)oriHr cilltririrclr (\)t)il l i
(,rrr,ll Ililizorzii
fi (,iri|lr(l ru tolsiIr(,. ,\(r,sl(,r lr l)Iizjlriri lrirli nll
r\rr)lIi Ir(ii (11l (ir)lr11lr rI jtlcriili, iI srlhihrl) so (k,fc{lorrzi t(,, .lr)
urs('r ti rr silll rl( sllrl (k, l)lt(ino.
lr'tt'rli)ta n i"ti.lti,tii tlttunl( sc Il(.o r,I llliollxiful. I,lrislr'1.
,lil'orilo iit)rri. irii Ii(!.iro rrc Lr l,ruii o lijr'] gnrLr1il,1)o cllc nl Iri|{l,ii
Ir rIrrsl)r'ir tx,ri(i( tx rli{,rxlicrlrrri-!. llolnlyuI r,s1(] xrqozr[l r'o pi(,io|r.r(i
$rl, ( llrs('nrl I I
I r I t i ti (11c ir rill l sn s{('lr ir) })ozi(ir! ci1 llu,i
,lrl.r I'ti. ('IIso11rl Isl(, lisli .ir)s, t)illri lx (1r I'[l l,(nllrvnl i, d I l)ri 0ur) s{l
l!trrl(,(iii t)t) li.il gl.lr(l lrj inirll,irrx,a (!,rt) lni. llIl t)r'(nrnil) l)rrriiil,do
laliorrx'lrr (slo rr1( fornrirl rlin sogr)ronto nrolllrll)ilci rrrrcslll sc
I

( ,

r r

Ix'riorlilizrrI){,Dir'Isiilliriliil(.in(xrrsillrrI]nc\oi1i (l ,)rlisuriil{)Ir{jlt.
.ii rto ( )ic,.lli() in lrozilir, (r'izoIillli.
MirnrnrcN rirlz\'ollririi rlIlrrl,llc r (('1)iil(r. rrliri ic Ix('( iI tro(li(l
rrrelr(,. &{,sli('tr inrl iglr(nl,uIi grirhl(i, pltfviizUlf (rr (rrrsorrl,! irr {nro
sinli (nl0r1i rl,l)ii. Ilirsuril,ro,r so fl((l iI l(clrHi Irt (1r fi L[r{ln]t. lr(i lininrl ()t'illll ix l'ozjtijr iniiDs, (llepi.
In, rirli(, oi'i. br ritl!no rurtr'oliollxin.i(le dcslinlrle l,e]Ii.rLL (,inlii
rirctxdrllilorsinit)r,c\'rizulcruotiiivcr,1klrLi"grarldl5ircIr,pecure
so porto (iiti,ti r^nillirrerr l)olnrlvnhri (iig. ltjii). Ace to l)alan1i,e pot fi
utilizalic pextru (l(lorrninanea ralxxlului (lintre grrtlateN c{rrl)oulii,

3.t9

exprimat5 lo liilograme $i iDd,ltinlea, bolDayului, exllimatb ln alecin]e

tri. Iaportul grcuta,te/inellime, esprimat ln valorile de mai Bus, estr
de 4,2 la birbali ti 3,9 la femei.
Boinarii adulii se clntlpsc la inteuane, epoi ale olicei ale iloui
orl Ic siptinini, precrrm ,qi in ziua plecarii. ln unelc a{eciiuni solr in
cn$ul lrnor tratamente cste ne(esar cs Dolnal-ul si, fie clntdrit in
fiecare zi, Daoi, staroa geDerald a
bolnavul nu pcDito ridicarea 1L1i
din pct Si..llezluea !c clDtar, atuDci
va fi clntdrit irD?rb Di cr patul
cu ajutorul urlui elntar care sr
iutrodnce sub pat. Astfel ln afecliunile insolite de ealeme (ca insuficienr, caxdia(.e,, afccliudle ruDal(,
cdcDl,Ltoasc, irr caz do cilozi es
cil,oge , sau olte {rfcctiud i!s(r
iite (le hidropizic) bollu,vul l,robui(
cintdrit zilDic, U|)rIIu ca, I n llrregi6trarca, (olrcorDitr(rutd, a g!(,
trtii corllomb, a lichidttor tottsttrnrto fi & dfurczci, sI )r(! III(,rir
orionta asu])m glaalulni (lc l(,1(n11ir
li(.hidirDi. Bollrovii suI)urri lrn1rrncDtului cu ]\(:TII sru corl iTr )1r \_r,1
Ii, sc ,aenreDca, cilltrrhil,i zilui(.
Corticotorapia favorizoezii l'01rirl(rla apei irr organisrn, itlr o datir
cn hcataron rdrninisl,nlrii Lorrx!
n-ir, ,6r. - Delnninare! lnn\imil bol- luhli apn acurDulatd, se olimiuil.
!avnhn.
S(,[dereo bru6d, a grertitii 0orpomle cu rndrhoo aliurezei !emn[rleazi, iace]erea eliminfuii licliidelor fixate sub forDr{, de edeDrc.
Daca diureza se meDline, iargaeutatea corpor':a,]5 stagDeazd,, iDBeaDri
ci,Iichialelo iDgerato slnt tn cantitete mai maro dcclt cantitatee pres'
criBd.

Pierilrile mari de lichiile pril1 Tirsituri $i auaxee aletermini o

scialero a grcut5lii corpora,le, inahcinal gradul de deshidmtale i
bolnavdui. Clntarirea ests obligatorie ln timpul tmtaDentului crl
meilicamento diulotic; als aseDeDea, cu ocazia sfabilirii tolelantei
{a.r,, de hi&atii de earbon la bolDarii diabetici. lE rodefta aleterminirii
metabolismului bazal, greotatea tEbuie stabiliti plecis.
350

a bolna.rului trebnie uotflt5 pe foaia dc

. GreutateaLa,corpoulll
tomlclrturii,.
ad ii, ,illotarea se iace in kilogmme; ln r[bricfl
lezervati, pontr[ :lccst rjcop ; Ia copitul mic, grcutatea corlomld cBtlr
roprezentath grrfic Ie sistiemul de oooraLonate rezeNat i]l moal special
pentru .Ldl1otll,Io.l, curbei ale dezyoltare potderrlS, a colilului.
sCURGERILE PATOLOG]CE ALE ORGANELOR OENITALE FEMIN NE

tihndolo mucoasci gonitalo sec&td o cantitatc rcdusd, do li(hid,

]o procesul do , loapdraro a aparatullr; qonirrl lx l.A,
,1, intcul,ii. To coudi!ii liziologi.o. .atrli(cl,.a a.e.t, i ., r'r.,lii ,.r,.
r'1l,rqi, c?a,lrcll, nll Ho {curgo nici o dai6 dio eal,:io Ii tl,r I rr,r nr',r, .,r:,
flrfaria. AcorLsli so.rolio coos{iruie loucoroco Iiziologici.
CfuraL .Lcoaslii, socrciis dovitro mai obundo[ti,, so (,xii(irioriz(,rzri
silL forll]lr ulroi sonrg(,r'i iritanto, dc (antiliate r:riabili $i Ura,rlil InrIlrir
h, dc lflrcorcc l:t,i r)l{)gi(ii. rutcor'i, scurgcrilo Hirrti .\rrlotii(,crlic Hall si[1,
lr)rrnatc nnrnlri {lin sirgc ; ill a{fl,r.[r l)erio alelor nlcDstT]rtlo, ar,(rsl(,x iIl o
s.nrnilical ic l)r lolosirii.
ilI Ir'r'zcr(,rr, rrn(]i ftslifel do sctrrgcri sc vor raliza canl,jL.rtcN,
, rrl,,r,r'. ,. :, rl, ,r rrl !^i rir n.l1 s, urgorjl,,r.
rrr"/;lal,/ (..t,, vxt,i.,l,itI da ln .,rti\.tr trrl. eiro L,ia Drilr 2ti luI
i irf,. ,.nnlribrri

i,ri.,h'hr.,r^j,piDnLr(.il,ovr,sur'.ml..rniItl.mlliilo,t,,niicIrn1il.,r,..l

l{,IColc(,i osLo rnicii,lu schirnb

( sto (Lr (rnljjt lro &bnnclcnljd,.

rr.
rr

rll

l[ ato(rliirrrlilf (1 fi! gon(,coci(,o sorlrgrrriL

(l rtitalr'tr Dr)lljc sii rl,jllsri 200 100 rnt

rl(. Ii,lrurre.
C loarro Ncllrgorilor poate

{(xnoiil{

)r'

fi

all)illilp1i)ilsir ir c,iz do lcurx)r(x.

ln llz (lo gorlo(oric, rofio ,,ponsitr srur
morilor organolr)l g(xrittLlo sru lorqio- piinr (i (l

1,incre, ghlLlrie-velzuio

ir cnzul l
]i)rnrati, 11itr slngc.
.{s?ecr{l s(xtrgc lor patologi(f(r r,sto rlo ascnnxn)a, Ioarlic alilcriL.
Sr,rrrgcr{,,1! sr:roasi, sau lnucoa!i,, allri satr iltco]or5,, in calllitato rc(lltsl
rllllfl, $i ls Jotie tinero $i se alatorcltc do obicei unei tulbur,,ri g(xrcr ,lo
r ir'{rnisjl]u1ui: a[emie, dcbilital,e, stare lim1aticS, etc.
S( rrgclea nmoo-purulontd, Bau pululent[ oste gi,lbdc san g]r,lbex[,
\ (,l'znir,, rlu nnlniros ?enehant lesping,ltor ;apaneln metritolo gorlo(jl), i,1. .ru dIlrrl arorr uri rptice.
Scrugor(.]l seroas5, fluid5,, puthal ajunge l)irfi la 400 mI in:d
rlc oro, allarc hr riaz do fibronr ute n, vi(,ir dc pozilie a ntoNlui, salpilIi1ie, tulbu hi ovan'ieIle scu ln [evmpatii.
r,rrfrrnic
,,sl11

Sc1lrgcrea sanguinolentS, fluidd, foil'to abuDdontrd, roqie-a,poasii

saiurleculoanecafcrricr (xrm os Iaal, apare tlr calrcerul orga[eloi genitalc.
Setr'gerea sanguinolontS-purdelrtii, ill cantitate mai icdusi,, se cons351

lald in,az dc inflanrAl,ii alc utarului .si io crz tle crorcr iole..t.t.
Sntttgcrer ro,.ic. lornril.5, prel)oodc|pDt. rtin singe, 5e .noirlrrii irl
caz dp a\orr. polipi xi rolul"i $nlleDdo,Dctrilr hemur.gi.p, dr.i
"irgerrrroa clrlrc irl alara lieftlorilor. renst.nrxlf.
ut sr tgctilor. Scnrgerilc pot fil"ontrolle sall lrur l,rrpx mii
. kn,
alp.
1., ol,or.ile. Unoori sc rrccct'i."cll,zri irr I,r'crir,.r rlrcnjrrll:1tiei.
daroriri c,,,,{Fitioi prcl'rcostnralc. tie inti rr'ti,:a s,irrs.r"u ,n suliin.r
lu nrijlorul ,i(lulIi Drcnst.nral srrb forrra rrnei scrrlii rtc Iicl,i,t i.t:rr
ca re)atinr, dalorilri hillcr$prrctici folii.utar".
SrIlrgorile hp rorngicc lot :rp6re:r sul, Ior rx unor ren.truatii
pr'clun:ile ti in r.cql c.rz lorbi||r ilc t|rou',ragir,,rrr in,.ur.rrl perioi{lelor nleDstrualc, cind yorbirn de nrelmragic. Ilenrolagia p;at6 fi
apontantr, or de exeuplu i[ filrronul terin, sau tprre rn-ai r ult provocrittrJ ca i[ (*n{rnrl rtedn.
din or.g:r.nole genit.rllc trebuie lrezonrrrr,,
-.Sccrctji)o\izi!d.
rredicnlui
I .patologitr.
Pentru rccolt.nrcu, s',urgrritor, rrirtenri vuupti t
lLn I urrpon de r il,,n (r,u dd gctd) la, r ulvll lrolnavei. tixinrlu-l r,u oiuionrl
uDui Ddndi lent in T. Tiulll,onul cu secrclie sc p[sireazi rurl-o tit\-ilt
rontra acol{.nl, (,u un.alac etraDHprurnt. T[vitu trlbllic de,i!
ii rrr.,at6: arlA, gate& dc substu,rrt(, dezinfe(unte Ilerts snlL
',uratd
Fub
tanrp(,n nu cilC lll-nuinil (i,ci .lonaaurraz6 nFpc(tul'.k.rcliti.
I'rezcnlireu re fri,c (u aiutorul r.lou* Isnse i nrinLiirel crr nririr, u
talrlpu-nului nu a{[(, udt ixi. Irul,I rc n foxt rizut dc lrLcdir., ([ xl)nr.
l,rroa lui, raurl)onul va ti urx;oi nu v:I fi ni(iodurtr :rLLncui rn cisul

do hlflii.ln Npjtolele
Doieazd,

d! spccialitote, felul di cnntit{tclr H(,urgcrilor

po fo,ria (le lontpelrtultr.
uRI'IAR|RCA ApARtTtEt

UNOI

Be

MAN|TESTAR| pATOLOGtCE

ln IfJri do crJrnporl:It'ront l fuDoliilor rital..(i leseturiv(, aii.leni rr Ir'Ir{riqirprrrili'r o\.ent,ualn lr, rl!or nrrrnitestrri l,at,,h,piri..
llp{1'perirpa

pt,crLr',o

:r tcenil,ora poi,te ra dca rheia ,liuEnr,rti,lrrlrri

i|ru poale froveni rrtrel(' r.o rllicAl.ii inst:rlat.c io.ursul b,,lilor.

V Tra .l'irntiIl. TrrDr|lir:r{ia estelln fexorren fjzioluqir r,rin orr,,
o+gdnisrlul r.i inloD*iti,n pierdefllcderfldulli. intr u ca"rtirr"
"*"".
siv, ane semnificrtie patologiri,, ptltlnd duce uneori h dcshiahataretr
orgadBDului. _Trrnspiulria porlte fi continutr sau periodictr, (,Il in
razul fobrplor inrcrnril{'ntc, s|}u An indioe }'lirlitul Unpi febre cotrinlle,
c, 0o exerrpru in cnza pneu roDic5. Adesea traDspirxlia rparc dul,i
un o}'ai nlai Dlr t sarl lrrei putin rcgulat.
Tlanspimt,ia poatc

tra[s]iralia lalmeior li
352

sd, aibd,

ull caracter rcgiotral. Astfel intilnim

in c&ul boiii tsrsedow.

,. plsntelor

l:lllonrca teoumtnl$lor. Coleqcflra datelor scmeiologi' c rehtiv

io sal'cin* mealinului. Tol,uii. aiislenta ln
ra roiotca Uoinaoirui
"r3s
tmbrtrcirji si dezbricirii boloavDlui, l,oalelei zilnice li cu ocazrc
",zirt
nlicAxii Droiiede;lor teBpeul,i( c, l,rebde se, observe bine tegumPDtelc
f,irtnnvutui. Dcnlru a Du-Lea scsiza modiJicirile surr_enite ln linrpul
iDlcrDnrji. ele pul iDd a;ea, imporl'rnitr llr rnolsrrl bolii
?aloarea ef,agelet5, a pielii se constati in caz de anemii Ei dc
iritar.e lnsulicienti, a pielii.'Paloarea insta,lati, ln Drod brusc se
d"
'lato'
i.Iin ,r" nti"ei unei'hertromsri. fto pierdorea uoei cartiteli
airisc. orsanisrnul se ancrniaii. O Paloi,re exlrcmi 5e conslclJ in
, ,"1*i Jo'"otrp" si 8oc dal,oril,tr :ralntr:irii sfurgelui in t asele rbtlomincl
cxrrsiv dlilatate, lipBind piclea de o iriga,rc suficiellti,.
l-ixIrozx se mcnltebti prin (uloarcn alhaslxi n tcgumeIrt'lor' I:t

,lxl,,r..l o I ulbfferjlor de hcnla.i.'24,, caro la'o si, sc xcumulezo hemr'_

,:i,'r'in.i rl,i,L*e 5n slngc, A.stfel cr ipcre in nfcrtiunile anarx-tului
rlsr,rr:rtor carc der.rDieaz, pmresul dc respiraliP, cr: ob.tacorc lrr
e:tlirr mrului. redu"r'ria supia,letei rcsphaturii, ftxu alt('rxra tutrctici
r,Ds.Iilor rciDiratori : dc asemenea, ln cursul aJoctiu[ilt r rlaratului
.inirtrttor iJdotite de insuficienta inimii dr"pte cu Ftaza venoastr
i.,,rsl'lLr1i1.[, pr'ecum gi la unele boli congeDilale ale ininlii.
l'irnoza uoate 8[ apar] ii localizatS, crnd circulolia do relntoar_
(erc rr urlci naiud estc deraniate, priDtr'o trombozl satt comf'IeQiuna
;rr..i !a;,'. D; Nate rplrca !i suh form6 dc crizo, cird urt o cauzi
a'.

$prBiidl,.

ll', .trt:r inkDsd, a Dielli Doa,te 84 lpar* in enrotii, ln curdul olor_

rrrlui iili,, l,ru lrr caz d6 febri. ln pncuhonie, iumatoter de lald dirr
t,rrl'.I xfcrtat, eFte mai rosie, cotrgtstionati. O ro|otd cnorm{li

rl'a},, [i lD uDclc fccriuDi hemoEgico.

t'r,l',[rli galbeDt a tpgunx\rlalor cpar itr coz de i(1erc -qau ltr
rrrr!lr, (r,ndrrnririi rlno! nrcdicomonle ctl: atebrtril, xcld plcrLc tc'
I(ii\Iul r(i rlxrlifestd, I)1ai ll1tli la iclerotics, putlnd al'a nua,n! lau
int oDAil {t i rl ileritc : icterul f taYin este gtlben_palial, ictrul ru}itr aro
o rru[D1?l rofin aselnd,IrStoaro cdorii portocalei, icterul verdia este
un ictei irn,urrs crr nuaDt{, vrdo, iflr icteml melaDio se caracterizsazi'
Irintr-o Dllanii neagri. Cotor:aii.l icterici, poate semnala alanilia
_unei
boli infoc6ioase, tle a,ceel Ya ii rsportattr iDlediat meiLcr ui'
ln cursul alife telor imbolnrviri pot si, opairi pigmentalii a,4orrllale alo piolii, (a ile exetnplu tuloarea galbeni ca paiul in cancr ii
limrDia porDicinrsi, culoarca bntui' ceDrr$e-mu]alni[ la cirozd, hepa_
tioi,r culoarea broDzlrti, in botln -{ddisont culoarca cetruqie_mtrralar
ir1 supumtii pulmoDare cxo[ice etc.

trdemul, Xdemul e8t un fcnomen Ioarte frecrent ln crrstl

bolilor rem,le, ca,raliace, carntiale sa,u itrllauatoar. Regiu[ea ealemaliati, este mai voluminoastr, pielea ma,i pa,lidi, lucie qi mai Btrlvezie,
nu prezinti cute, cSci piele.a qi lesutul sllbcuia&at slnt i!.{liltrate cu
semzitate. Pielealiipierile elasticita,tea Si pistreazd un oatreca,re timp

urmele de presiune a tlegetelor. OaIemuI poato li loealizat sau generalirzl ;5D al.e8I uliir).M vorbim de anasarci,.
Edernul de cu.loare albd, loc!,liza,t mai tntii 1a pleoape, apoi la
organolo gonita,le, se datorelte uDol alecriuni rcna,le.
ndemul, iDsorit de ciaDozS, localizat iniiial ln pe,4ils declivo
ale corpului, se datore$te stazei !enoa6e. Xl poate {i loca,lizat, clnd.
staza yenoasd eBte dletemina,td de un ob6tacol itr calea unei vene, ca :
ttomboza, comprcsiulea, extcmd, do crfie o tumoanc etc., sau geDeralizat ln alecriuDile candiaae Si pulmonano, calo, prio in8uficienla
iuirEii dreptc, creeaz{, o 6taz{, geoera,le, h siBtmul yeoos. El ee mai
Ilumeite 9i calem a,lbostru.
ndomul Burrcnit Ia bolnayi caqecl.ici, conrerc$i, tuberulo$i,
subnutrili Eau dupd perioade lungi do iDaDilio, lo di8trolii bopatico etc,
apars ca o coo8eciDld a, scdile i proteinelor plasrnatico li roilucorii
Ue8iunii coloid-ogmotice e siDgelui qi poant6 numele alo eilem caqootic.
ndemul ds ouloaro roqie localizax lo jurul proceselor inflamotorc
poartil, Dumolo tlo odom inlla,mator.
Idomul poat6 aye, fi o cauzd alergictr, cLEd vorlim ale edm
&ngiolourotio.
Doseuatrraliile. Dcscua,ma,liile hobuie obseryaB cll mai l)Ieooao,
elo putlnal somnalo o boald, infeciioa6t, p n care boIDA$ul a tmcnt
xecent. Iiecunoaiteroa ei poato contibui la Bia,bilirea diagnostioului
bolii aotna,lo. Prczenta, doscuamdrilor ole o mano hll,oltatri!, lE Epecial
]a copiii la caro bolile inlectioase lnsolito als alescuamtrri Blnt mai
irecvento,
Bo ya olserva caraotorrl dcscua,maliei, er putltrd Ii : lurfuracee,
lamelaxi sau ln lambouri gi s6 va rrporto mealicului caractorul ci
oaact, rsgiunse ti timpul ln ca,re a, &pEnui.
tsruptiile culanate. ENpliile coatanate pot apSrea ln culsrll
Bpitalizrrii. Ile trcbuic obscrvatc Si seDna,lrto imediat mealicului,
putlnal rcprezcDta boli iDfecto-coDtagioaae. Erupiiile cuatanate pot fi
determinate de :
toli iDIeclioase acut: scarlatini, mjeoli, mtreold, va cel5,
febM-tiioide, tiIoB exantematic, herpes, erizipel !i e zipeloid, zotrA I
rcaciii alergice, ct: urtica c, boa,la, sInlui t
- hipercxcitabilitatea,
nervilor yasomotori &i pielii, ca, drtrgile
Trousseall qj alermogra,fismul, care alar uneo ln medngite, neurastoDie, boala Ba8ealo'ir etc.;
354

toric,i {i de sensibilizrre c uoor subslaolc mcdica- actiunpa

m.[toase;
ca : chiDitra, aDl,ipirioa, beladona. lrromul, iodnl. rrlicilaLul,
modha qi xneori altibioticle.
Ecmoragiile rut naae pol, apirea de la o zi la alta. Ele trpbuie
Ier[ooscDte itr Jaza, preeoce, c]6ci pot, fi somoale de al, rmd a unor stiri
homoragipaxe Eau septice loarte graye. Pot al)drea sub lorme, de
homoragii mici, punctifome, ova.lare $r,u rolunale, alenunfte peteiii,
sau sub formd ale p15,ci hemoragice ile extifialere mai nrare, numito
echimoze. Caracterul lor lremoragic sc difeientriazi, de eruptriile congeslire priE faplul cd Du drspar h pre8irlnoa digilxli.
flemoragiile cul xnatc pol, [i insori[ de bomoragii a]l' tnrL.oaqclor :
cpistaxis, hemoragii gitrgivale, hem^tetDezi, lnele i, etc. nb apar,n
currul bolilor iDlectioase a,clrtc, in bolile organelor hem{Ltopoie1iro, 5D afrctirrDilo hsolil,o de insulicionl,b hopaticd, tu cxz ile avi{aminuza, jrr.rum qi itr cursul inl,oyicatiilor medicamenroase, fiind
delormiDllrc do lulburr,ri do c.oagulare o shgelui, de o modificaro
rr-rrrrilatirir . u futr(lioDald s tmrnbocitelor sau do o fragilitalo capiltrri oxagelati, de Baturd toxict 8au irfeclioasd.
llemomgiilo do l& dvelul plooapolor fli (oDjucliYclor, caro apar
ttr cursu.I acceEolor do tuser ao datoresc uDeori sl,az(i venoasc.
Poroz0le ti paraliziilo. AsistoDta va observa dacu, Ee itrstaleazd
liulburtrni d.o Eotlicitate la bolnavul tngrijit. Delicitul motor poato
Ii pa,rtial, cltrd vorbim de pa&zo, 6au poa,to li total, cind vorbim d.o
l,oru-Iizjj. nrr, trobuio 6r, ttie st localizezo delicit,ul motor Ia : mcmbrclo
inferio[e, superioare, mu6culatura, trunchiului, mufcLii Jrlei etc,,
apoi dacd intereseazd utr mombTu ln intregime, sau numai {urumito
grupo mus.ulare. Itr a,casl, ull,im caz sc va orienta dacd. paralizia
interssoazl mai Eu.lt mu8cula,tu& pmximald a mombrului atim sau,
dimpotriyS,
rn6i mult muEculatola distal6.
_Paraliziile
pot fi psrilc ca 6au centra,le. ln primul naz este
arin8 EorlroEDl perifsric, membrul paralizat oste Ilasc, moale, lip6it
de loEicital,c Si mitciirilo pasive pol, li xecul,a,te cu o cmplitudiue m ult
rna,i mBrB. Itr a,l doilea caz, membrul atioa s[e spxslic, cu totrusul
pdstrat, chia,r exagemt i milcirile pasiye so pot executa cu o amllitudino mnli mai mici.
ABisteDta adunl datele privind paraliziile Si parozole exclusiy
prin obBervDlie. na nu ane dreptul ale a fuce lncerciri seu tsntative
de miqc5ri cu lrrlile pam,lizate, a.sasta putiqd duce la agravarea
Btdrii bolnarului.
Paxaliziilo Dembrelor pot li itrBoiit ale para,Iizia &uscnlaturii
vezicii urinare sau rectului, c4a ce so traduco pai{ letedrie do uriDd
qi feca,lo, sau do pax&lizia sfincte&lor, chil aparts lenomonul de incontinenrd udnand !i cL materri feca,le.

Asistnta trebuie sii 6e a,lnti Ia orice mrniteslare Datolosici a

Iroltrayulai; anginele, modiricdiile aspectDl[i timbii, tniburSrifc dc
BoD3ibi]ita,te, c.r, gi orice simptom subiectiy semnalat ile bolnav (pe
care acest&, tle multe ori, pitr-d la vizita mediculni il dtd), trebuie sn
fie- aduse la cunoqtiDrs aestuia,, cdci Dumai prir as;Bt6 strlo$n
colaborare 'rDtre asistenti ti medic s vs polet ffmnri htr-adeeir
$tiiBrif ic stares, bolna,yului.